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Respiratory > Asthma > Flashcards

Asthma Flashcards

1
Q

Briefly describe the pathophysiology of asthma

A

(Reversible) narrowing of the airway due to:

  • Smooth muscle contraction (bronchoconstriction)
  • Mucosal inflammation
  • Increased mucus production
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2
Q

Describe the clinical features of asthma (in terms of the symptoms and their pattern)

A

Symptoms:

  • Cough (dry)
  • Wheeze
  • SOB

Pattern:

  • Episodic
  • Diurnal variation
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3
Q

Asthma is associated with with which other conditions?

A

Eczema and hayfever (atopic triad)

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4
Q

Describe some of the typical asthma triggers

A

NICE guidelines:

  • Exercise
  • Infection
  • Exposure to cold air or allergens (e.g. dust/pollen)
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5
Q

Which classes of drugs may be contraindicated in asthmatic patients?

A
  • NSAIDs

- Beta blockers

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6
Q

Which investigations are recommended by NICE for diagnosis of asthma?

A

First line:

  • Fractional exhaled nitric oxide (FENO)
  • Spirometry (with bronchodilator reversibility)

If there is still diagnostic uncertainty, these tests can be followed up with:

  • Peak flow variability (diary)
  • Direct bronchial challenge test (with histamine or metacholine)
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7
Q

Describe the first three steps in the pharmacological management of asthma (according to NICE guidelines)

A
  1. SABA, e.g. salbutamol
  2. Low dose ICS, e.g. beclomethasone
  3. LTRA, e.g. montelukast
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8
Q

Which class of drug does salbutamol belong to?

Describe the mechanism of action

A

Short-acting beta-2 agonist (SABA)

Activation of beta-2 receptors in airways causes smooth muscle relaxation and airway dilatation (short duration of action)

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9
Q

Which class of drug does salmeterol belong to?

Describe the mechanism of action

A

Long-acting beta-2 agonist (LABA)

Activation of beta-2 receptors in airways causes smooth muscle relaxation and airway dilatation (long duration of action)

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10
Q

Which class of drug does beclomethasone belong to?

Describe the mechanism of action

A

Inhaled corticosteroids (ICS)

Reduce inflammation and reactivity of the airways

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11
Q

Which class of drug does montelukast belong to?

Describe the mechanism of action

A

Leukotriene receptor antagonist (LTRA)

Leukotrienes are produced by the immune system and cause inflammation, bronchoconstriction and mucus production. LTRAs block the effects of leukotrienes.

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12
Q

Describe the mechanism of action of theophylline

What is important to remember about theophylline?

A

Relaxes bronchial smooth muscle and reduces inflammation

IMPORTANT: theophylline has a narrow therapeutic window and requires plasma level monitoring

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13
Q

What is MART?

A

MART stands for Maintenance and Reliever Therapy

This is a combination inhaler containing both an ICS and a fast-acting LABA - this replaces all other inhalers and the patient uses this inhaler as both a “preventer” and a “reliever”

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14
Q

Describe the conservative management of asthma

A
  • Smoking cessation

- Avoid allergens, e.g. dust/pollen

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15
Q

Describe the classification of acute asthma exacerbation (NICE guidelines)

A
  • Moderate
  • Severe
  • Life threatening
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16
Q

What are the criteria for a moderate asthma exacerbation?

A

All of the following:

  • Reduced PEFR (50-75% of best/predicted)
  • Normal speech
  • No features of severe or life threatening exacerbation
17
Q

What are the criteria for an acute severe asthma exacerbation?

A

One of the following:

  • Reduced PEFR (33-50% of best/predicted)
  • Tachypnoea
  • Tachycardia
  • Inability to complete sentence in one breath, or use of accessory muscles of respiration
  • Reduced sats (but still >92%)
18
Q

What are the criteria for a life threatening asthma exacerbation?

A

One of the following:

  • Reduced PEFR (< 33% of best/predicted)
  • Oxygen sats < 92%
  • Altered consciousness/confusion
  • Exhaustion
  • Cyanosis
  • Silent chest
19
Q

Describe the initial management of an acute asthma exacerbation

A

ABCDE approach

OSHITME:

  • Oxygen
  • Salbutamol (nebs)
  • Hydrocortisone
  • Ipratropium (nebs)
  • Theophylline
  • Magnesium sulfate
  • Early senior involvement
20
Q

What may you discover on an ABG in a patient having an acute asthma exacerbation?

A
  • Initially, patients may have a respiratory alkalosis (as tachypnoea means blowing off more CO2)
  • Hypoxia and normal CO2 are worrying signs as these suggest the patient is tiring
  • High CO2 (and therefore respiratory acidosis) is a VERY worrying sign
21
Q

When giving back-to-back salbutamol, which side effects should you be wary of?

A
  • Hypokalaemia

- Tachycardia

22
Q

Describe the algorithm for management of hypokalaemia

A

If serum potassium 3.0-3.5:
- Oral replacement (potassium chloride, also known as Sando-K)

If serum potassium 2.5-3.0:

  • Symptoms? Existing cardiac disease? ECG changes?
  • If no to above, give oral replacement
  • If yes to above, give IV replacement (see below)

If serum potassium < 2.5:
- IV replacement (potassium chloride)

23
Q

When giving IV potassium replacement, what is the maximum:

a) concentration of infusion
b) rate of infusion

A

a) 40 mmol/L

b) 10 mmol/hour

24
Q

What is the normal serum potassium level?

A

3.5 - 5.0

25
Q

Which class of drug does tiotropium belong to?

Describe the mechanism of action

A

Long acting muscarinic antagonist (LAMA)

LAMAs block acetylcholine receptors. Acetylcholine receptors are stimulated by the parasympathetic nervous system and cause bronchoconstriction. Blocking these receptors leads to bronchodilation.

26
Q

Which vaccinations are asthmatic patients offered? How often?

A

Flu jab (annually)

Respiratory (9 decks)

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