Asthma Flashcards
What is asthma?
a disease characterise by an increased responsiveness of the airways to various stimuli and manifested by a widespread narrowing of the airways that changes in severity either spontaneously or as a result of therapy
What is the main symptom of asthma?
Wheezing
Is asthma restrictive or obstructive?
Obstructive
What is COPD?
Chronic, slowly progressive disorder that is characterised by airflow obstruction - does not change markedly over several months
Is asthma triggered by a stimulus or spontaneously?
Can be either
Is the airflow obstruction in asthma reversible?
Yes
If there is no wheeze can it be asthma?
No
What is dyspnoea?
Shortness of breath
What are the symptoms of asthma?
Wheeze Short of breath Severity chest tightness Cough (usually dry) Sputum occasionally
Is asthma more common in boys or girls?
Boys
Is asthma more common in men or women?
Women
What is the prevalence of asthma in children?
10-15%
What is the prevalence of asthma in adults?
5-10%
What is wheezing?
A whistling sounds that occurs during breathing when the airways are narrowed
What is the character of a cough in asthma?
Dry
What are some potential triggers of asthma?
Exercise Cold air Smoke Perfume Grass pollen Pets
What are the obs taken in a patient with suspected asthma?
Ability to speak
Heart rate
Respiratory rate
O2 saturation
What is bronchospasm?
When the smooth muscle of the airways contract therefore narrowing the airways
What is bronchiectasis?
The abnormal widening of one or more airways
In bronchiectasis what is extra produced?
Extra mucus
Prone to infection
What other conditions can wheezing occur in?
Cystic fibrosis
An infection in the respiratory tract
Bronchiolitis
Bronchiectasis
What is peak flow investigation?
Patients are given a peak flow meter to use at home to encourage self monitoring
Record a peak flow diary
Doctor looks at the diary and looks to see if the range is out with 15%
In moderate asthma what is the PERF?
> 50-75%
In acute severe asthma what is the PERF?
33-50%
In life threatening asthma what is the PERF?
Less than 33%
Essentially None
Test not possible
As the person will not be able to breathe out
What are some of the symptoms of acute severe asthma?
Heart rate >110 bpm
Inability to complete sentences in one breath
What are the clinical signs of life threatening asthma?
Altered consciousness Exhaustion Hypotension Cyanosis Silent chest Poor respiratory effort
What are the similarities between COPD and asthma?
Both involve small airways and cause airflow limitation
Both result from environment interaction
Both are usually characterised by mucus and bronchoconstriction
Why is asthma so important?
Because so many people suffer from the condition
Is asthma chronic or a one off condition?
Chronic
How does smoking link to asthma?
Maternal and grandmother smoking during pregnancy
What are possible risk factors for asthma?
Obesity
Diet
Reduced exposure to microbes
Indoor pollution
Is wheezing only present in asthma?
No it can be present in other conditions meaning it is important to differentiate it from other causes of wheeze
Is the airflow obstruction in asthma reversible?
Yes
Is wheezing more prominent when you breathe in or out with asthma?
Breathe out
If the beta 2 agonist drugs work what is the likely diagnosis?
Asthma
When should peak flow at home be measured?
In the morning and night
If in doubt of an asthma patient what should be measured?
Blood gas
What are the different types of asthma?
Occupational related
Allergy
Genetic
What are some triggers for asthma?
Pets Cold Dust Exercise Perfume Food Allergens Occupationally related
Does physical examination aid in the diagnosis of asthma?
Not really
What are some useful but not diagnostic investigations for asthma?
CXR
Skin pricking test
Specific and total IgE
FBC - eosinophilia
Will eosinophilia be present in COPD patients or in asthma patients?
Asthma patients
What 2 techniques can be used to measure lung function?
Spirometry
Peak Flow
Why are lung function test carried out before and after taking a bronchodilator?
To check the reversibility of the airflow obstruction
If the use of a bronchodilator improves symptoms and lung function it is likely you have asthma
What can a nitric oxide test indicate for asthma?
High NO exhaled levels can sometimes be present in patients presenting with asthma
Is occupational asthma common or uncommon in children?
uncommon
Describe moderate asthma?
Able to speak and complete sentences
HR<110
RR<25
PERF 50-75%
Describe severe asthma?
Any of Unable to speak HR>110 RR>25 PERF - 33-50%
Describe life threatening asthma?
any of grunting impaired consciousness HR>130 Cyanosis PaO2 is low But PCO2 is normal
What is the main indication of near fatal asthma?
High PCO2
Describe a cough in a child with asthma?
Dry
Nocturnal
Exertional
If a child is wheezing but does not respond to treatment what is the diagnosis?
Viral induced wheeze
is asthma more common in under 18 months or over 5 years old?
Over 5
If you think its asthma
but you are not sure…
Give a short course of inhaled steroids
and see if you have a cure
What 2 main groups of drugs are given to asthma patients?
Anti-inflammatorys
Bronchodilators
What medication should you never give to an asthma patient?
Beta blockers
What are some pharmacological solutions to asthma?
Weight loss if BMI >30 Vaccines - yearly for flu and pneumonia Allergen avoidance Smoking cessation Physiotherapy
What does MDI stand for?
Metered does inhalers
Why are MDI great for treating asthma?
Deliver small amounts of the drug
Delivered straight to the target organ - lungs
Onset of effect is faster
Minimal systemic exposure - especially because they’re steroids
Who can find it difficult to use an inhaler device?
The young
Old
Uncoordinated
What device can be used to aid with the use of an inhaler?
Spacer
What is defined as the complete control of asthma?
No daytime symptoms No night time disruption No need to reuse medication No asthma attacks No limitations on activities
What is a reliever?
SABA
Blue inhaler
What is the most prescribed drug in the UK?
Salbutamol
Should you start on high or low doses of reliever inhalers?
Low
What is an ICS?
Inhaled corticosteroids
What do ICS do?
They work to prevent the onset of asthma symptoms
What is a common ICS prescribed?
Beclomethasone
when do you start a patient on preventers?
When using reliever x3 times a week
Waking one night a week or more due to asthma
Requiring oral steroid for an exacerbation in the past 2 years
Often symptomatic
Which LAB is commonly used?
Fostair
What is the 5 step asthma treatment plan?
Reliever SABA Add a preventer Add a LABA Add an anti-muscarinic Oral steroids
What inhalers will you be prescribing as an FY1?
Inhaled steroids
SABA
ICS
LABA
What should you always have prescribed before starting a patient on LABA treatment?
ICS preventer
Is there a cure for asthma?
No
What is the maximum dose of inhale that can be given to children?
800 microg
What CANNOT be prescribed to children?
Oral steroids
