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Year 3 Med 1 > Asthma > Flashcards

Asthma Flashcards

1
Q

Pathophysiology

A

Asthma occurs due to a reversible airway obstruction.

The pathophysiology of asthma includes airway narrowing due to bronchial muscle contraction, inflammation caused by mast cell degranulation and increased mucus production.

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2
Q

Symptoms of asthma

A
  • Wheeze
  • Dyspnoea
  • Cough (may be nocturnal)
  • Chest tightness
  • Diurnal variation (symptoms often worse in the morning)
  • Note: a personal/family history of atopy may be present, and symptoms may worsen following exercise or NSAIDs/beta-blockers
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3
Q

Signs of asthma

A
  • Tachypnoea
  • Hyperinflated chest
  • Hyper-resonance on chest percussion
  • Decreased air entry (sign of severe illness: silent chest)
  • Wheeze on auscultation
  • Signs of a severe attack: inability to speak in complete sentences, respiratory rate >25, peak flow 33-50% predicted
  • Signs of a life-threatening attack: silent chest, confusion, bradycardia, cyanosis, exhaustion
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4
Q

Investigations in acute asthma

A

he following investigations should be ordered more urgently in the context of an acute asthma attack.

  • ABG: type 2 respiratory failure (low PaO2 and high PaCO2) is a sign of a life-threatening attack.
  • Routine blood tests (including FBC, CRP): to look for precipitating causes of an asthma attack, such as an infection.
  • Chest x-ray: to exclude differentials and possibly identify a precipitating
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5
Q

Investigations in chronic asthma

A
  • Peak flow: variability >20%
  • Fractional exhaled nitric oxide (FeNO): >40 ppb in adults or >35 ppb in children
  • Spirometry: FEV1/FVC <0.7 (obstructive spirometry)
  • Bronchodilator reversibility tests: Improvement of FEV1 >12% after bronchodilator therapy is diagnostic
  • History-
  • Day to day diurnal variability.
  • Episodic symptoms.
  • Relationship to exposures.
  • Occupational / irritants.
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6
Q

Management of an acute asthma attack

A
  • Ensure a patent airway
  • Ensure oxygen saturations of 94-98%
  • Nebulisers: Salbutamol, Ipratropium
  • Steroids: oral Prednisolone or IV Hydrocortisone (if severe)
  • IV Magnesium Sulphate: if severe
  • IV aminophylline: if severe and inadequate bronchodilatory response from nebulisers
  • If the patient does not improve following these measures, intensive care input will be required for consideration of an intensive care admission which may involve invasive ventilation.
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7
Q

Non-pharmacological management of chronic asthma

A
  • Smoking cessation
  • Avoidance of precipitating factors (eg. known allergens)
  • Review inhaler technique
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8
Q

pharmacological management of chronic asthma

A

stepwise approach

Step 1: short-acting inhaled B2-agonist SABA (eg. Salbutamol)

Step 2: add low-dose inhaled corticosteroid steroid (ICS)

Step 3: add long-acting B2-agonist LABA (eg. Salmeterol). If no benefit, stop this and increase ICS dose; if benefit but inadequate control, continue and increase ICS dose.

Step 4: Trial oral leukotriene receptor antagonist, high-dose steroid, oral B2-agonist

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9
Q

Risk factors

A
  • Personal or family history of atopy
  • Antenatal factors; maternal smoking, viral infection during pregnancy (especially RSV)
  • Low birth weight
  • Not being breastfed
  • Exposure to high concs of allergens
  • Air pollution
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10
Q

“Hygiene hypothesis”

A

increased risk of asthma and other allergic conditions in developed countries. Reduced exposure to infectious agents in childhood prevents normal development of the immune system resulting in Th2 predominant response.

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11
Q

Associated atopic conditions: IgE mediated

A
  • Atopic dermatitis (eczema)
  • Allergic rhinitis (hay fever)
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12
Q

What is FEV1 and FVC

effect of asthma of FEV1 and FVC

A

FEV1: forced expiratory volume- volume that has been exhaled at the end of the first second of forced expiration

FVC: forced vital capacity- volume that has been exhaled after a maximal expiration following a full inspiration

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13
Q

differntial diagnoses for wheeze

A
  • COPD- fixed airflow obstruction
  • Upper airway obstruction- stridor
  • Foreign body
  • HYpernventilation syndrome
  • Anxiety
  • Gastro-oesophageal syndrome
  • Pulmonary oedema
  • Eosinophilic vasculitis
  • Respiratory bronchiolitis
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14
Q

new alternative therapies for asthma management

A
  • MART therapies- fostair
  • Omaluzimab- monoclonal antibody of IgE
  • Reslizumab- monoclonal antibody to Il5
  • Mepoluzimab- monoclonal antibody to Il-5 (s/c/)
  • Benralizumab- Il-5
  • Bronchial thermoplasty- diathermy bronchial smooth muscle
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Year 3 Med 1 (10 decks)

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