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Finals - CardioResp > Asthma > Flashcards

Asthma Flashcards

1
Q

Pathophysiology of Asthma? (3)

A
  1. Airway narrowing due to broncoconstriction
  2. Inflammation caused by mast cell degranulation
  3. Increased mucus production
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2
Q

List 4 symptoms of Asthma?

A
  1. Dry cough with wheeze
  2. Chest tightness
  3. Dyspnoea
  4. diurnal variation
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3
Q

What Family history is linked to asthma?

A

Family history of Asthma or Hx of other atopic conditions

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4
Q

List 4 signs of Asthma on examination

A
  1. Chest deformities
  2. Hyperinflation
  3. Hyper-resonance due to hyperinflation
  4. Prolonged expiratory phase with expiratory wheeze on auscultation
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5
Q

Describe the pattern of symptoms in Asthma?

A

Episodic and diurnal variability of symptoms (tend to be worst at night)

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6
Q

Is airway obstruction in asthma reversible or irreversible?

A

reversible

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7
Q

List 4 typical triggers of Asthma

A
  1. Dust (house dust mites)
  2. Animals
  3. Cold air
  4. Exercise
  5. Smoke
  6. Food allergens
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8
Q

Describe the wheeze heard in Asthma

A

Bilateral widespread “polyphonic” wheeze

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9
Q

First line investigation for Asthma

A

Spirometry FEV1/FVC <70%

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10
Q

List the investigations for Asthma

(In order)

A
  1. Spirometry with reversibility testing (>5yrs)
  2. Fractional exhaled nitric oxide (FeNO)
  3. Direct bronchial challenge test
  4. Peak flow variability
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11
Q

Stepwise management of Asthma?

A
  1. SABA
  2. SABA + ICS
  3. SABA + ICS + LRA
  4. SABA + ICS + LRA + LABA
    • MART
    • Theophylline
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12
Q

Example of a SABA?

A

Salbutamol

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13
Q

Example of a LABA?

A

Salmeterol

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14
Q

Example of a LRA?

A

Montelukast

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15
Q

Example of a LAMA

A

Tiotropium

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16
Q

What is Maintenance and Reliever Therapy (MART)

A

Combination inhaler containing low dose ICS and fast acting LABA

Replaces all other inhalers as both a “preventer” and “reliever”

17
Q

How does an Acute Asthma exacerbation present?

A
  1. Progressively worsening SOB
  2. Signs of respiratory distress
  3. Tachypnoea
  4. Expiratory wheeze on auscultation
  5. Reduced air entry, chest sounds “tight” on auscultation
18
Q

What is a silent chest?

Why is it worrying?

A

Airways are so tight, it is not possible to move enough air through the airways to create a wheeze

+

Reduce respiratory effort due to fatigue

19
Q

PEFR in moderate vs severe vs life threatening Asthma

A

Moderate: 50 – 75% predicted

Severe: 33-50% predicted

Life threatening: <33%

20
Q

List 4 features of severe asthma

A
  1. PEFR 33-50% predicted
  2. Resp rate >25
  3. Heart rate >110
  4. Unable to complete sentences
21
Q

List 4 features of life-threatening Asthma

A
  1. PEFR < 33%
  2. Sats < 92%
  3. Becoming tired
  4. No wheeze - “silent chest”
  5. Haemodynamic instability (i.e. shock)
22
Q

What would happen to the pO2 and pCO2 in an acute asthma attack

Incl initial changes AND prolonged changes

A

Initally: pO2 is low and pCO2 is low due to V/Q mismatch. pCO2 is low due to hyperventilation

Prolonged: pO2 is low and pCO2 is increases as ventilation is reduced by obstruction

23
Q

What will ABGs in Asthma show?

Incl initial changes AND prolonged changes

A

Initially: respiratory alkalosis

Prolonged: may progress to respiratory acidosis - very bad sign due to high CO2

24
Q

Treatment of Moderate Asthma

(OSHI)

A
  1. Oxygen
  2. Nebulised Salbutamol
  3. Oral prednisolone or IV Hydrocortisone
  4. Nebulised Ipratropium bromide
  5. Antibiotics if evidence of bacterial infection
25
Q

Treatment of Severe Asthma

(OSHIT)

A
  1. Oxygen
  2. Nebulised Salbutamol
  3. Oral prednisolone or IV Hydrocortisone
  4. Nebulised Ipratropium bromide
  5. Tiotropium Bromide
  6. Antibiotics if evidence of bacterial infection
26
Q

Treatment of life threatening Asthma?

(OH SHIT ME)

A
  1. Oxygen
  2. Nebulised Salbutamol
  3. Oral prednisolone or IV Hydrocortisone
  4. Nebulised Ipratropium bromide
  5. Tiotropium Bromide
  6. Magnesium Sulfate
  7. Escalate
27
Q

What is the significance of a normal pCO2 or hypoxia on ABG during a life threatening asthma?

A

Very worrying as it means the patient is tiring

28
Q

List 4 ways we can monitor response to treatment?

A
  1. Respiratory rate
  2. Respiratory effort
  3. Peak flow
  4. Oxygen saturations
  5. Chest auscultation
29
Q

What must be monitored whilst on salbutamol?

Why?

A

Serum K+

Salbutamol causes potassium to be absorbed from the blood into the cells.

Can also causes tachycardia

30
Q

When does NICE suggest referral to a respiratory specialist for Asthma?

A

After 2 attacks in 12 months

31
Q

Explain a typical step down regime of inhaled salbutamol once control is established

A
  1. 10 puffs 2 hourly then
  2. 10 puffs 4 hourly then
  3. 6 puffs 4 hourly then
  4. 4 puffs 6 hourly

They prescribe a reducing regime of salbutamol to continue at home

32
Q

Explain the direct challenge test

A

???

33
Q

How is Peak flow variability measured?

A

Patient advised to keep a diary of peak flow measurements several times a day for 2 to 4 weeks

34
Q

Gold standard investigation for diagnosis of Asthma

A

Finals - CardioResp (18 decks)

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