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Respiratory Medicine > Asthma > Flashcards

Asthma Flashcards

1
Q

What are the symptoms of asthma?

A 
Wheeze
SOB
Cough
Chest tightness
Variable expiratory airflow limitation
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2
Q

What are the main categories of medication use in asthma?

A

Beta agonists - works on smooth muscle to relax airways

Corticosteroids - reduced influx of inflammatory cells e.g. eosinophils. Prevents the release of inflammatory mediators that would cause airway contsriction

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3
Q

What are some bronchodilators?

A

Relievers

SABA - salbutamol, bricanyl

LABA - salmetarol, formoterol

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4
Q

What are some corticosteroids?

A

Controllers

ICS - beclomethasone, flucticasone

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5
Q

What are the processes of personalised asthma management?

A

Assess

  • confirm diagnosis
  • symptom control/modifiable RFs
  • Inhaler technique/adherene

Adjust

  • Treatment of modifiable RFs and co-morbidities
  • Non-pharmacological strategies
  • Asthma medications
  • Education and skills training

Review

  • Symptoms
  • Exacerbations
  • Side-effects
  • Lung function
  • Patient satisfactions
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6
Q

What investigations are done for asthma?

A

Spirometry: FEV1 and FVC
FeNO
Maybe CXR in older patients with history of smoking

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7
Q

What is FEV1?

A

volume that has been exhaled at the end of the first second of forced expiration

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8
Q

What is FVC?

A

olume that has been exhaled after a maximal expiration following a full inspiration

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9
Q

What results are typically seen on spirometry in asthma?

A

FEV1 - significantly reduced
FVC - normal
FEV1% (FEV1/FVC) < 70%

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10
Q

What does FeNO levels correlate with?

A

Inflammation - produced by inflammatory cells in the lungs

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11
Q

What are the features of SABAs?

A 
e.g. Salbutamol 
First line
Used when symptoms develop
Blue 'reliever' inhaler 
Relax smooth muscle of airway
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12
Q

What are the side effects of SABAs?

A

Tremor

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13
Q

When are ICS’s used?

A

When asthma is not controlled by SABA alone
Taken everyday regardless of symptomatic or not
‘preventer’

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14
Q

What are side effects of ICS’s?

A

Oral candidiasis

Stunted growth

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15
Q

What class of drug is montelukast?

A

Leukotriene receptor agonist

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16
Q

What is considered a positive FeNo result?

A

in adults level of >= 40 parts per billion

in children a level of >= 35 parts per billion

17
Q

What is the management for newly diagnosed asthma?

A

SABA

18
Q

What is the management for asthma not controlled by SABA?

A

SABA + low dose ICS

19
Q

What is step three in asthma management?

A

SABA + low-dose ICS + leukotriene receptor antagonist e.g. Montelukast

20
Q

What is step 4 in asthma management?

A

SABA + low-dose ICS + LABA

continue leukotriene receptor antagonist e.g. Montelukast if helpful

21
Q

What is step 5 in asthma management?

A

SABA +/- LTRA

Switch ICS/LABA for maintenance and reliever therapy (MART)

22
Q

What is MART?

A

a form of combined ICS and LABA treatment in which a single inhaler

23
Q

What are the features of acute asthma?

A

worsening dyspnoea, wheeze and cough that is not responding to salbutamol
maybe triggered by a respiratory tract infection

24
Q

How do we stratify acute asthma?

A

Moderate
Severe
Life threatening

25
Q

What are the features of moderate acute asthma?

A

PEFR 50-75% best or predicted
Speech normal
RR < 25 / min
Pulse < 110 bpm

26
Q

What are the features of severe acute asthma?

A

PEFR 33 - 50% best or predicted
Can’t complete sentences
RR > 25/min
Pulse > 110 bpm

27
Q

What are the features of life-threatening acute asthma?

A 
PEFR < 33% best or predicted
Oxygen sats < 92%
Silent chest, cyanosis or feeble respiratory effort
Bradycardia, dysrhythmia or hypotension
Exhaustion, confusion or coma
28
Q

What is the management for acute asthma?

A

Life-threatening - admission
Severe - admit if refractory to initial treatment

O2 if hypoxaemic (15L non-rebreathe mask)

high dose SABA

40-50mg prednisolone orally

Ipratropium bromide if above not satisfactory

IV magnesium sulphate

29
Q

What is ACOS?

A

Asthma-COPD overlap syndrome
Worse symptoms and QoL
Increased risk of exacerbations

30
Q

How is ACOS defined?

A

Persistent airflow obstruction with features of asthma

Respiratory Medicine (12 decks)

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