asthma Flashcards
in children what is the aetiology of asthma?
environment, infection, abnormal physiology, hereditary factors and also epithelial abnormality exposed to allergy may fuel asthma
how do you diagnose asthma in children?
no diagnostic test, often causes a dry nocturnal cough, a wheeze and affects quality of life but responds to treatment
spirometry then bronchodilator response then nitric oxide test then peak flow
what is asthma?
chronic panting, wheeze, cough, shortness of breath when at rest
what is a predominant trigger for asthma in children?
upper respiratory tract infection
what are the 6 meds used for asthma in children ?
short acting beta agonist inhales corticosteroids (ICS) leukotriene receptor antagonist theophylline oral steroids
what are the first line preventers in under 5’s?
ICS and LTRA
whats the max dosage of ICS in children?
800micrograms
what are some negative effects of ICS in children?
0.5-1cm decrease in height
oral thrush
adrenocortical supply with purple and orange inhalers
if a child patient is poorly controlled in low dose of ICS what should you add?
LABA
what are the goals of treatment in children with asthma?
minimal symptoms
minimal need for relief meds
no attacks
no limitation in physical activity
in children diagnosis of asthma what does SANE stand for?
S-short acting beta agonist (more than twice a week)
A-absence from school etc
N-nocturnal symptoms
E-exceptional symptoms
what are the 2 delivery systems used in children ?
metered dose inhaler with spacer device (8% deposition)
dry powder device- not for under 5’s and boys cannot use until 8, 20% lung deposition
how should a metered dose inhaler with space device be used?
shake inhaler between puffs and wash with thin layer of detergent monthly to reduce static
what meds would you use in children with mild asthma?
SABA via spacer or SABA+prednisolone (pred)
whats meds would you use in children with moderate asthma?
SABA via nebuliser+prednisolone
SABA+epitome bromide via nebuliser+prednisolone
what meds would you use in children with severe asthma?
intravenous- salbutamol
aminophylline
magnesium+prednisolone
hydrocortisone
intimate and ventilate is very severe, rare cases!
in children how do you choose between medication?
respiratory rate work of breathing heart rate O2 saturations ability to complete sentences confusion air entry
how would chronic vs acute asthma be treated in children?
chronic- inhaled steroid
acute- oral steroids
what are risk factors in adults?
hereditary(mostly maternal)
smoking
occupation
environmental
what is meant by atopy?
the body’s predisposition to develop IgE in response to exposure to environmental allergens
atopy is inheritable and associated with allergic rhinitis, asthma, hay fever and eczema
what are symptoms of asthma in adults?
medical history, wheeze, dyspnoea, chest tightness, dry cough and sputum
whats some evidence of variable symptoms?
daily variation- nocturnal, early in the morning
weekly variation- occupation, does is go away on weekends? or on holiday?
annual variation- environmental allergens
what could trigger asthma in adults?
exercise, cold air, cigarettes, respiratory tract infection, pets, pollen, drugs and food
what are some clinical symptoms that could point to another diagnosis that not asthma?
finger clubbing
stridor (inspiratory wheeze instead of expiratory)
asymmetrical expansion
crepitations (crackles)
how would you measure the severity of an acute asthma episode ?
ability to speak heart rate respiratory rate peak flow O2 saturation arterial blood gas
what symptoms would a patient with moderate acute asthma present?
able to speak heart rate less than 110bpm respiratory rate less than 25 peak flow 50-75% SaO2 less than or equal to 92% PaO2 less than or equal to 8kPa
what symptoms would a patient with severe acute asthma present ?
inability to complete sentences in one breath
heart rate more than or equal to 110bpm
respiratory rate more than or equal to 25
peak flow 35-50%
SaO2 less than or equal to 92%
PaO2 less than or equal to 8kPa
what symptoms would a patient with life threatening acute asthma present?
grunting impaired consciousness ad confusion bradycardia (less than 60bpm), arrhythmia, hypotension peak flow less than 33% cyanosis(skin or lips turn blue) silent chest SaO2 less than 92% PaO2 less than 8kPa PaCO2 normal
what symptoms would a patient with near fatal acute asthma present?
raised PaCO2
needs medical ventilation
what are non pharmacological ways to manage asthma ?
exercise
smoking cessation
weight management
patient education
what are the SABA relievers used in adults?
salbutamol
terbutaline
what oral therapy meds are used in adults?
LTRA
theophylline
prednisolone
what are some specialist therapies used in rare and severe cases of asthma in adults?
omalizumab
mepolizumab
bronchial thermoplasty
