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Asthma * Flashcards

1
Q

What type of disease is Asthma

A 
Chronic Reversible airway obstruction
Airway hyperresponsiveness
Inflamed bronchioles 
Mucus hypersecretion
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2
Q

What is asthma

A

Chronic reversible airway obstruction due to

  • bronchial muscle contraction
  • mast cell degranulation
  • increased mucus production
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3
Q

What causes airway narrowing in asthma

A

TH2 Overexpression
TH2 CK release = IgE and eosinophils recruited
Mast cell degranulation leading to inflammation
Increased mucus secretion and bronchial constriction

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4
Q

What are the Presenatations of asthma

A 
Dyspnoea and Tacypnoea
Inflated silent chest
Cough and SOB
Wheeze on auscultation
Diurnal variation
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5
Q

What are the signs of a fatal asthma attack

A 
Silent chest
Bradycardia
Confusion
Cyanosis
Exhaustion
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6
Q

What are the risk factors for Asthma

A

Atopy (Allegic tendency)
Low birth weight
Not breastfed
Allergen exposure
Hygiene Hypothesis
Passive smoking

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7
Q

What investigations are done for asthma

A

*Spirometry
-FEV1/FVC <0.7
-FeNO >35
Bronchodilator reversibility (>12% Inc.FEV1)
ABG (look for type 2 resp fail)

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8
Q

What are the results for asthmatic spirometry

A 
>20% variability on peak flow
Reduced FEV1
Normal FVC
FEV1/FVC <0.7
12% FEV1 Increase = diagnosed
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9
Q

For bronchodilator reversibility, what FEV1 Improvement value determines asthma

A

12% raise

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10
Q

How do you manage an Asthma attack

OSHIIT

A 
O-Oxygen (94-98)
S-Salbutamol nebuliser
H-Hydrocortisone/Prednisolone
I- Ipratropium
I- IV Magnesium Sulphate
T-Theophylline/Aminophylline
ICU
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11
Q

How do you manage Chronic Asthma in a child

A 
SABA
SABA + ICS
Check Inhaler compliance/technique
SABA + ICS + LTRA
SABA + ICS + LABA (+/LTRA)
Increase ICS Dose
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12
Q

What is an example of SABA

A

Salbutomol

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13
Q

What is ICS for asthma

A

Inhaled CorticoSteroids (hydrocortisone)

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14
Q

What is an example of LTRA

A

Montelukast

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15
Q

What is an example of LABA

A

Salmeterol

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16
Q

How do you manage Asthma in an adult

A

SABA
SABA + ICS
SABA + ICS + LTRA
SABA + ICS + LABA (can add LTRA)

17
Q

What is the Atopic triad

A

Atopic Rhinitis
Asthma
Eczema

18
Q

What is Samster’s Triad

A

Nasal polyps
Asthma
Aspirin sensitivity

19
Q

What is the pathology of Asthma

A

Over-expressed TH2 in airways react to trigger
TH2 release cytokines (3,4,5 and 13) = IgE Production
Eosinophils release toxic proteins
IgE = mast cell degranulation = histamines, leukotriens and tryptase released
Bronchial constriction and mucus prouduction occurs

20
Q

What hypersensitivity is Asthma

A

IgE T1 Hypersensitivity

21
Q

What are the asthmatic triggers

A 
Infection
Allergens
Cold
Exercise
Drugs(Aspirin and BB!)
22
Q

What can happen overtime in Chronic Asthma

A

Chronic remodelling

-Bronchial scarring = narrow lumen = Hypermucus secretion

23
Q

What does the allergy overexpress in the immune pathway of asthma

A

TH2 Receptors

24
Q

What does TH2 Release in response to being over expressed

A

Cytokine release = IgE Production and Eosinophil recuitment
-IL3/4/5/13

Eosinophil release = toxins

25
Q

Mast cell degranulation results in what release

A

Histamine
Leukotriens
Tryptase

26
Q

How do you manage asthma exacerbations

A

OSHIIT
-Oxygen
-Salbutomol
-Hydrocortisone
-Ipratropium
-IV Mag Sulfate as bronchodilator
-Theophyline IV

-Escalate -> CPAP/BiPAP

27
Q

Describe the 4 different asthma episode types

A

Moderate
-PEF 50-75%
Severe
-PEF 33-50%
Life Threatening
-PEF <33%
Fatal
-Hypercapnoea

28
Q

Why is aspirin contraindicated in asthma

A

Aspirin inhibits COX1/2
Arachidonic acid shunts down LPOX pathway
Leukotreines produced = More inflammation

29
Q

What does microscopy of mucus in asthma show

A

Carshmen spirals
Leyton charcot crystals

30
Q

What is allergic asthma

A

IgE mediated T1 Hypersensitivity
-Cause = Environment and Hygiene Hypothesis

31
Q

What is non allergic asthma

A

Non IgE mediated
Associated with smoking

32
Q

What is the hygiene hypothesis in asthma

A

The cleaner the environment growing up = The more likely you are to get asthma

33
Q

Why may an ABG be done in asthma

A

Assess for Type 2 Resp fail

34
Q

What causes T1 resp fail

A

Fibrosis
-Lung can’t fill properly
Treated w/ CPAP

35
Q

What causes T2 resp fail

A

Obstruction
-Can’t remove C02
Treated w/ BiPAP

36
Q

On ABG what is the difference between T1 and T2

A

T1 - low oxygen and C02
T2 - Low oxygen w/ raised CO2

37
Q

State the OSHITME management for asthma exacerbations

A

Oxygen
Salbutamol
Hydrocortisone
IV Magnesium sulfate (Bronchodilator)
Theophyline IV
Magnesium sulfate
Escalate

38
Q

Why is magnesium sulfate used in Asthma

A

As a bronchodilator

39
Q

What ventilation should always be used in asthma

Resp (14 decks)

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