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Asthma * Flashcards

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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

Study These Flashcards
A

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

17
Q

What is the Atopic triad

Study These Flashcards
A

Atopic Rhinitis
Asthma
Eczema

18
Q

What is Samster’s Triad

Study These Flashcards
A

Nasal polyps
Asthma
Aspirin sensitivity

19
Q

What is the pathology of Asthma

Study These Flashcards
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

Study These Flashcards
A

IgE T1 Hypersensitivity

21
Q

What are the asthmatic triggers

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

What can happen overtime in Chronic Asthma

Study These Flashcards
A

Chronic remodelling

-Bronchial scarring = narrow lumen = Hypermucus secretion

23
Q

What does the allergy overexpress in the immune pathway of asthma

Study These Flashcards
A

TH2 Receptors

24
Q

What does TH2 Release in response to being over expressed

Study These Flashcards
A

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

Eosinophil release = toxins

25
Mast cell degranulation results in what release
Histamine Leukotriens Tryptase
26
How do you manage asthma exacerbations
OSHIIT -Oxygen -Salbutomol -Hydrocortisone -Ipratropium -IV Mag Sulfate as bronchodilator -Theophyline IV -Escalate -> CPAP/BiPAP
27
Describe the 4 different asthma episode types
Moderate -PEF 50-75% Severe -PEF 33-50% Life Threatening -PEF <33% Fatal -Hypercapnoea
28
Why is aspirin contraindicated in asthma
Aspirin inhibits COX1/2 Arachidonic acid shunts down LPOX pathway Leukotreines produced = More inflammation
29
What does microscopy of mucus in asthma show
Carshmen spirals Leyton charcot crystals
30
What is allergic asthma
IgE mediated T1 Hypersensitivity -Cause = Environment and Hygiene Hypothesis
31
What is non allergic asthma
Non IgE mediated Associated with smoking
32
What is the hygiene hypothesis in asthma
The cleaner the environment growing up = The more likely you are to get asthma
33
Why may an ABG be done in asthma
Assess for Type 2 Resp fail
34
What causes T1 resp fail
Fibrosis -Lung can't fill properly Treated w/ CPAP
35
What causes T2 resp fail
Obstruction -Can't remove C02 Treated w/ BiPAP
36
On ABG what is the difference between T1 and T2
T1 - low oxygen and C02 T2 - Low oxygen w/ raised CO2
37
State the OSHITME management for asthma exacerbations
Oxygen Salbutamol Hydrocortisone IV Magnesium sulfate (Bronchodilator) Theophyline IV Magnesium sulfate Escalate
38
Why is magnesium sulfate used in Asthma
As a bronchodilator
39
What ventilation should always be used in asthma
BiPAP

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