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Medicine > Asthma > Flashcards

Asthma Flashcards

1
Q

Define Asthma

A

Asthma is characterized as recurrent episodes of dyspneoa, wheeze, and cough caused by reversible airway obstruction.

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2
Q

What three factors contribute to airway narrowing in asthma

A
  • Brochial muscle constriction
  • Mucosal swelling/inflammation
  • Excess mucus production
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3
Q

What causes mucosal inflammation/swelling in asthma?

A

Mast cell and basophil degranulation resulting in the release of inflammatory mediators

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4
Q

List symptoms of asthma

A
  • Wheeze
  • intermittent dyspnoea
  • cough (oft. nocturnal)
  • sputum
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5
Q

List some precipitants of asthma attacks

A
  • allergens (dust mite, pollen, pests, fur)
  • Exercise
  • Smoking (passive smoking too)
  • Infection
  • Pollutants
  • NSAIDs & Beta Blockers
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6
Q

Describe what is meant by the term diurnal variation when used in the context of asthma

A

This is the marked decrease in peak flow rate in the dusk of the morning when compared with the peak flow rate during the day or at night.

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7
Q

What precipitants may be present in the home of a asthma patient?

A
  • Pets
  • Pests
  • Carpets (with hidden dust mites)
  • feather pillows
  • any soft furnishing
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8
Q

What would indicate that the asthma precipitants may be work related?

A

If the symptoms remit on weekends or holidays

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9
Q

which occupations are more likely to have occupational asthma?

A

welders
paint sprayers
animall handlers
food processors

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10
Q

List some signs of an asthma attack

A
  • tachypnoea
  • audible wheeze
  • hyperinflated chest
  • hyper resonant percussion note
  • decreased air entry
  • polyphonic wheeze
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11
Q

List some signs of a severe asthma attack

A
  • breath rate >25bpm
  • Pulse rate >110bpm
  • Inability to complete sentences
  • PEF = 33-50%
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12
Q

List some signs of life threatening asthma attack

A 
Silent Chest
Confusion
exhaustion
Cyanosis 
Bradycardia
PEF <33%
low PaO2 <8kPa but normal PaCO2
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13
Q

List one important sign of near fatal asthma attack

A

Increased PaCO2

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14
Q

List some tests done to confirm Acute Asthma attack

A
  • PEF : peak expiratory flow
  • ABG: arterial blood gas
  • CBC
  • U and E
  • Blood Culture
  • C-reactive protein test
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15
Q

What will an arterial blood gas test show in a patient with acute asthma attack

A
  • normal or slightly decreased PaO2

- decreased PaCO2 (because of hyperventilation)

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16
Q

What should be done if the patient’s PaCO2 is normal or raised

A

Transfer to Intensive therapy unit for ventilation, as this signifies failing respiratory effort

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17
Q

Why would you do a CXR on a patient with acute asthma attack

A

To rule out infection or pneumothorax

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18
Q

In chronic asthma PEF monitoring will show..

A

a diurnal variation of >20% on >/= 3days a week for 2 weeks

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19
Q

In chronic asthma a Spirometry test will show…

A

decreased forced expiratory volume 1sec (FEV1), normal forced vital capacity

ratio <75%

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20
Q

A chest x ray will show what presentation in a chronic asthmatic

A

Hyperinflation

21
Q

What test is used to help identify allergens in Chronic asthma

A

Skin prick test

22
Q

List some differentials for asthma

A
  • Pulmonary Oedema (Cardiac asthma)
  • Bronchiectasis
  • Pulmonary embolism
  • Large airway obstruction
  • obliterative brochiolitis
  • Superior vena cava obstruction
  • pneumothorax
23
Q

List 2 diseases and 1 syndrome that can be associated with asthma

A
  • Acid reflux
  • polyarteritis nodosa
  • Churd-Strauss Syndrome
24
Q

What is Polyarteritis nodosa

A

is a rare disease that results from blood vessel inflammation (“vasculitis”) causing injury to organ systems.

25
Q

What are the three factors of Churd-Strauss Syndrome triad

A
  • asthma
  • hypereosinophilia
  • pulmonary infiltrates
26
Q

Which guideline is used in the management of asthma

A

British Guideline for the management of asthma

27
Q

What is step 1 in the British Guideline for management of asthma

A

Step 1: Occasional use of inhaled short-acting

β -adrenoreceptor agonist bronchodilator

28
Q

What is step 2 in the management of asthma according to the British Guidelines?

A

Introduction of a regular preventer ; preferably an inaled glucocorticoid

29
Q

What is step 3 in the British Guideline for management of asthma

A

Add on therapy ; long acting B2 agonist (with the inhaled glucocorticoid)

30
Q

What is step 4 in the British Guideline for management of asthma

A

Step 4: Poor control on moderate dose of inhaled glucocorticoid and add-on therapy: addition of a fourth drug

31
Q

What is step 5 in the British Guideline for management of asthma

A

Add regular oral prednisolone (1 dose daily, at the lowest possible dose). Continue with high-dose inhaled steroids. Refer to asthma clinic.

32
Q

Describe the steps in the management fo acute severe asthma

A
  • Oxygen therapy
  • High dose bronchodilators
  • Systemic Glucocorticoids
33
Q

Define the step-down therapy method in the treatment of chronic asthma

A

nce asthma control is established, the dose of inhaled (or oral) glucocorticoid should be titrated to the lowest dose at which effective control of asthma is maintained.

34
Q

Give two examples of SABAs used in step1 of chronic asthma treatment

A
  • salbutamol

- terbutaline

35
Q

List 3 inhaled glucocorticoids used in step 2 treatment of chronic asthma

A

Beclometasone
Budesonide (BUD)
Fluticasone

36
Q

What are the criteria for stepping up a chronic asthmatic with step 1 treatment to step 2 treatment

A

for any patient who:
• has experienced an exacerbation of asthma in the last 2 years
• uses inhaled β2-agonists three times a week or more
• reports symptoms three times a week or more
• is awakened by asthma one night per week

37
Q

What is a resonable starting dose of beclometasone for adults stepping up to step 2 treatment?

A

400 micrograms per day (may be increased in smokers)

38
Q

What should be done before stepping up to step 3 if a patient remains poorly controlled despite regular use of an inhaled glucocorticoid

A

Check:

  • meds adherence
  • inhaler technique
  • ongoing exposure to modifiable aggrevating factor
39
Q

Add on therpay (step 3) should be considered if the patient’s inhaled glucocorticoid dose is greater than or equal to what value

A

> 800 micrograms per day

40
Q

Give 2 examples of a LABA (long acting b2 agonist) used in the add on therpay (step 3) of chronic asthma treatment

A

Salmeterol

Formoterol

41
Q

Combination therapy of LABA and inhaled glucocorticoid is advised as LABA monotherapy has what side-effect

A

increased risk of life-threatening attacks

42
Q

which two drugs are used in inhaled glucocorticoid-LABA therapy

A

Budesonide + Formoterol

43
Q

In step 4 of chronic asthma management what are 4 drug class options that can be added to achieve control?

A
  • slow releasing B2 agonist
  • Aminophylline (Theophylline)
  • Long acting anti-muscarinic agents
  • leukotriene receptor anatagonist
44
Q

Describe the MOA of B2-adrenoceptor agonist in asthma control

A

relax bronchial smooth muscle, acting within minutes.

45
Q

What are some side effects of B2 agonists

A

tachyarrythmia

46
Q

Describe the MOA of inhaled glucocorticoid (corticosteroid) in asthma control

A

The act over days to reduce brochomucosall inflammation

47
Q

What precaustion should be taken after inhaling glucocorticoids?

A

Rinse mouth - to prevent oral candidiasis

48
Q

What is the MOA of aminophylline/theophylline in asthma management?

A

acts by inhibiting phosphodiesterase (which reduces cAMP availabilty- so reduced muscle contraction) thus < bronchoconstriction

Medicine (14 decks)

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