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Year 3 Med 1 > Asthma > Flashcards

Asthma Flashcards

1
Q

LOs

A
  • Understand and describe the physiology of common causes of wheeze
  • Understand the causes, presentation, diagnosis, monitoring and management of acute and chronic asthma
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2
Q

What is asthma?

A
  • It is a chronic inflammatory airway disease characterised by:
    • Chronic bronchiole inflammation
    • Airway hyper-responsiveness
    • Bronchoconstriction (obstructive airflow limitations)
  • Day to day diurnal variability in symptoms → PEFR (peak expiratory flow rate) variation >20%
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3
Q

What are the forms of bronchial asthma?

A
  • Eosinophilic
  • Non eosinophilic
  • Occupational (due to something in the workspace)
  • Irritant induced,
  • Exercise induced bronchospasm
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4
Q

What causes wheeze?

A
  • COPD (fixed)
  • Asthma (reversible)
  • Pulmonary oedema (cardiac wheeze)
  • Bronchiectasis
  • Upper airway obstruction (STRIDOR)
  • Foreign body
  • Gastro-oesophageal syndrome
  • Eosinophilic vasculitis
  • Respiratory bronchiectasis (post viral infection)
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5
Q

What are the signs & symptoms of asthma?

A
  • Wheeze → widespread polyphonic wheeze
  • Intermittent breathlessness → diurnal (at night worse)
  • Cough
  • Triggers e.g. dust, pets
  • Hyper-inflated chest
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6
Q

Draw and label the bronchiole tree

A
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7
Q

What is the pathophysiological role of eosinophils?

A
  • End stage granulocytes
  • IL-5 is the principle growth factor
  • Migrate into tissue from peripheral blood – commonly from intestinal mucosa
  • If hyper-E0 syndromes correct with steroids: inflammatory; if fails – malignant
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8
Q

What are the causes of hypereosinophilia?

A
  • Drugs
  • Allergic fungal disease eg allergic bronchopulmonary aspergillosis
  • Eosinophilic granulomatosis – polyangiitis
  • Eosinophilic pneumonia
  • Asthma
  • Parasitic infection
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9
Q

What are the clinical features of asthma? (history and examination)

A

History

  • Symptoms of respiratory pathology e.g. wheeze, cough, SOB & if diurnal
  • Triggers? → pets, temp, occupational exposure, smoking (makes asthma worse)
  • Personal or family history → ATOPY (allergies)
  • Assessing asthma severity:
    • Peak expiratory flow rate (PEFR)
    • Adherence to treatment
    • Attendance hospital/ICU
    • Normal requirement for SABA

Examination

  • Sometimes normal respiratory exam
  • BEDSIDE → Oxygen, inhaler, spacer, PEFR meter
  • INSPECTION → cyanosis, increased work of breathing, audible wheeze
  • Peripheries → fine tremor, tachycardia, oral candida (steroid inhaler us)
  • Chest → polyphonic expiratory wheeze
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10
Q

What are the risk factors & triggers for asthma?

A
  • Pets (allergic/sensitiser induced asthma)
  • Stress
  • Certain medications
    • Beta-blockers and NSAIDs can exacerbate asthma
  • Dust → trigger history e.g. occupation
  • Chemicals and perfumes
    • Irritant induced asthma
      • Substance caused irritation and then inflammation lining the airways (damage recognised leading to immune system response)
  • Air pollutants
  • Smoking
  • Genetic
    • Atopic history
    • Prematurity and low birth weight
  • Respiratory infections
  • Some foods and beverages
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11
Q

What is occupational asthma?

A
  • Considered when patient symptoms IMPROVE when not at work
  • Usually >1 year after started work as takes time for sensitivity to develop
  • Sensitiser induced (enzymes classical ‘allergen’ response) OR irritant induced (chemicals cause inflammation → immune response → inflammed
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12
Q

How to diagnose asthma?

A
  • Symptomology: day to day diurnal variability in core symptoms; history of triggers (allergic / non allergic)
  • Functional: Peak expiraotry with diurnal variability (20%); dynamic airflow obstruction >15% post BD FEV1, CXR → hyperinflation, IgE blood test, sputum eosinophilia
  • CLINICAL
    • Day to day diurnal variability
    • Episodic symptoms
    • Relationship to exposures
    • Occupational/irritants
  • Allergic/non-allergic
    • History
    • RAST (rapid antigen specific testing)
    • IGE blood tests
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13
Q

How to assess the impact of asthma?

A
  • Number of SABA uses per day/week
  • Number of days missed from school/work
  • Nocturnal symptoms
  • Any recent exacerbations
  • Ever required hospital attendance?
  • Ever been admitted to intensive care?
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14
Q

Explain the chronic management of asthma

A
  • CONSERVATIVE
    • Smoking cessation/avoiding triggers
    • PEFR daily
    • Regular asthma reviews → personal asthma plan & inhaler technique education
    • Vaccinations
  • MEDICAL
    • Salbutamol (side effects: tachycardia, tremor)
    • Inhaled corticosteroid (side effect: oral candida → thrush)
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15
Q

How would you safety net an asthma patient?

A
  • Use SABA >3x a week = GP
  • <4 hour gaps between weekly requirements of salbutamol = GO A&E
  • 10 puffs salbutamol with NO symptom relief → call 999
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16
Q

What are the complications of asthma?

A

Exacerbations

  • Can be infective OR non-infective
  • Triad: bronchospasm (hyperresponsiveness to something), mucosal thickening, mucous production → all of these usually lead to hyperventilation

Pneumothorax

  • Secondary pneumothorax may develop during an asthma exacerbation → drain required
17
Q

What are normal PEF rates for different ages?

A
18
Q

Illustrate the difference in obstructive and restrictive spirometry readings

A
19
Q

How to grade different severities of asthma?

A
20
Q

What investigations would you do to someone with asthma?

A

BEDSIDE

  • Peak flow → mild <100%, moderate <75%, severe <50%, life threatening <33%)
  • Obs
  • Sputum culture
  • ECG (salbutamol → tachycardia and arrythmias)

TESTS

  • FBC (raised eosinophils)
  • CRP
  • ABG (assess perfusion)
  • Specific RAST test (identify specific IgE to allergens → confirm trigger)

IMAGING

  • CXR → rule out pneumothorax
  • Spirometry → confirm obstructive disease
21
Q

What is the management of someone with asthma?

A

Acute management

Oxygen

Help

Salbutamol

Hdrocortisone

Ipratropium

Theophyline

Magnesium

Escalate

  1. Salbutamol nebulisers 5mg+/- ipratropium
  2. PO prednisolone 40mg OR IV hydrocortisone
    1. Antibiotics
  3. If life threatening → ICU
  4. Discharge → ensure stable for 4 hours following discharge (& PEFR returned to >75%)
22
Q

When is it not safe to send an acute asthmatic home?

A
  • Exacerbation whilst on steroidds
  • History of poor compliance to treatment
  • History of depression/anxiety
  • History of severe/refractory asthma (e.g. ICU)
  • Pregnancy
  • Poor social circumstances
23
Q

Chart of treatment of asthma

A

Year 3 Med 1 (19 decks)

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