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Finals: Medicine > Asthma > Flashcards

Asthma Flashcards

1
Q

What are the 3 key characteristic features of asthma

A

Reversible airflow limitation

Airway hyperresponsiveness

Inflammation of the bronchi

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2
Q

Define asthma

A

Defined as chronic inflammatory disorder of the airways secondary to type 1 hypersensitivity

Asthma is characterised by intermittent airway obstruction and hyper-reactivity

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3
Q

Asthma is an example of:

a) Obstructive lung disease
b) Restrictive lung disease

A

a) Obstructive lung disease

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4
Q

What type of hypersensitivity reaction is associated with asthma

A

Type 1 hypersensitivity reaction

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5
Q

Describe the pathogenesis of asthma

A
  • On insult by the trigger, results in type 1 hypersensitivity reaction causing mast cell degranulation and histamine release
  • Mast cell degranulation and histamine causes smooth muscle contraction causing the bronchoconstriction
  • Inflammation causes increased bronchial hyper-responsiveness contributing to the bronchoconstriction
  • Bronchoconstriction is where the smooth muscles of the airways (the bronchi) contract causing a reduction in the diameter of the airways leading to airflow obstruction
  • Bronchoconstriction is often reversible, either spontaneously or with treatment such as salbutamol a bronchodilator.

NOTE: Remember the immune system has to be primed with the trigger i.e. the first exposure primes the immune system so little response however the immune system is now ready to respond when next exposed

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6
Q

Name the two types of asthma

A

Atopic: extrinsic – triggered by environmental factors

Non-atopic: intrinsic – not caused by exposure to an allergen

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7
Q

Give examples of the triggers for asthma

A

History of atopy

Aspirin induced

Occupational asthma

Exercise induced

Allergies e.g. house dust mites, animal fur, pollen

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8
Q

What is atopy

A

Genetic predisposition to IgE mediated allergen sensitivity.

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9
Q

Name the 3 IgE medicated atopic conditions

A

Asthma

Atopic dermatitis i.e. eczema

Allergic rhinitis i.e. hay fever

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10
Q

Name the symptoms of asthma

A

SoB

Chest tightness

Expiratory wheeze

Cough (often worse at night)

Diurnal variation (symptoms often worse in the morning)

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11
Q

The cough associated with asthma is worse at what time of the day

A

At night

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12
Q

Asthma symptoms are often worse at what time of the day

A

In the morning

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13
Q

Name some of the signs of asthma

A

Tachypnoea (high RR)

Hyperinflated chest

Hyper-resonance on chest percussion

Use of accessory muscles

Reduced peak expiratory flow rate (PEFR)

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14
Q

How is asthma diagnosed

A

Clinical diagnosis - history alone is enough

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15
Q

What two investigations can be used to confirm a diagnosis of asthma

A

Fractional exhaled nitric oxide

Spirometry with bronchodilator reversibility

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16
Q

How does fractional exhaled nitric oxide (FeNO) work in the investigation of asthma

A

A type of nitric oxide synthases rises in inflammatory cells, particularly eosinophils

The level directly correlates to the level of eosinophilic airway inflammation

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17
Q

What level of fractional exhaled nitric oxide (FeNO) supports a diagnosis of asthma

A

> 40

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18
Q

What pattern would be present in spirometry for asthma

A

Asthma is an obstructive lung disease and therefore an obstructive pattern will be seen

“Church steeple form on the flow volume chart

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19
Q

What pattern is shown below (Spirometry results):

Reduced FEV1

Normal FVC

Reduced FEV1/FVC ratio

A

Obstructive lung pattern

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20
Q

What pattern is shown below (Spirometry results):

Reduced FEV1

Reduced FVC

Normal FEV1/FVC ratio

A

Restrictive lung pattern

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21
Q

How do we determine if the FEV1 is reduced

A

<80% of the predicted FEV1 value

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22
Q

How do we determine if the FVC is reduced

A

<80% of the predicted FVC value

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23
Q

How do we determine if the FEV1/FVC ratio is reduced

A

< 0.7

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24
Q

What are the two axis of the flow volume chart

A

Volume (L) - x axis

Flow (L/sec) - y axis

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25
Q

The spirometry results for asthma are reversible with bronchodilators. What bronchodilator is used

A

Salbumtaol

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26
Q

The spirometry results for asthma are reversible with bronchodilators.

What value is improved with a bronchodilator

A

FEV1 improve which in turn improves the FEV1/FVC ratio

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27
Q

Asthma is chronically managed with inhaler.

What is a non-pharmacological aspect of managing asthma

A

Help to quit smoking.

Avoid precipitants/triggers

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28
Q

Patients are given two types of inhaler in the chronic management of asthma.

Name these two types

A

Reliever inhalers

Preventer inhaler

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29
Q

Give an example of a reliver inhaler for managing chronic asthma

A

Short acting beta agonist (SABA) e.g. salbutamol

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30
Q

When should reliever inhalers (As part of the management of asthma) be used

A

Used when needed to quickly relieve asthma symptoms for a short time. Should only be used occasionally as too much salbutamol can cause sudden death.

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31
Q

How many times a week of reliever inhaler use would you consider ‘stepping up’ therapy.

A

Three times a week

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32
Q

Which type of inhaler should be used daily even in the absence of asthma symptoms?

a) Reliever inhalers
b) Preventer inhalers

A

b) Preventer inhalers

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33
Q

When should SABA be consider as a monotherapy in the management of asthma

A

For those with infrequent exacerbations and normal lung function.

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34
Q

What is the first line preventer inhaler in the management of asthma

A

Inhaled corticosteroids (ICS)

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35
Q

What is the second line inhaler management of asthma

A

ICS + Leukotriene receptor antagonist (LTRA)

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36
Q

What is the third line inhaler management of asthma

A

ICS + Long acting beta agonist (LABA) +/- LTRA

Keeping LTRA depends on the responsiveness they have been to this medication. If not, remove

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37
Q

What is the fourth line inhaler management of asthma

A

Maintenance and reliver therapy (MART) +/- LTRA

Keeping LTRA depends on the responsiveness they have been to this medication. If not, remove

38
Q

Give an example of a short acting beta 2 agonist (SABA)

A

Salbutamol

39
Q

When is SABA used in the management of asthma

A

The first-line drug to be used in the reliever management of asthma

Can be used as a monotherapy management option in cases of very mild asthma however commonly it is used alongside preventer inhaler(s)

40
Q

What is a potential side effect of SABA

A

Tremor

41
Q

What is the target of SABA

A

beta 2 adrenergic receptor, which are located in the bronchioles of the lungs

42
Q

Why is it important that the beta agonist used in the manage of asthma is specific to beta 2 adrenergic receptors

A

To limit off target effects of the medication

There are two types of beta adrenergic receptors: Beta 1 and beta 2

Beta 1 are found in the heart and stimulation of these increases the heart rate and contractibility

Beta 2 receptors are located in the bronchioles of the lungs

43
Q

There are two types of beta adrenergic receptors: Beta 1 and beta 2.

Where are beta 1 receptors located and what are their function?

A

Beta 1 are found in the heart and stimulation of these increases the heart rate and contractibility

44
Q

There are two types of beta adrenergic receptors: Beta 1 and beta 2.

Where are beta 2 receptors located and what are their function?

A

Beta 2 receptors are located in the bronchioles of the lungs

45
Q

What inhaler are patients referring to when they say “blue inhaler” - used in asthma

A

Salbutamol (SABA)

46
Q

Give an example of the inahled corticosteroids (ICS)

[management of asthma]

A

Beclometasone

Fluticasone propionate

47
Q

At what stage in the management of asthma are inhaled corticosteroids (ICS) inhaler used

A

It is the 1st line preventer inhaler

Used alongside SABA (SABA is for symptom relief but no long term effects)

48
Q

What a potential side effect of inhaled corticosteroids (ICS) inhaler

[management of asthma]

A

Oral candidiasis

Shunted growth in children

49
Q

Give an example of a long acting beta 2 agonist (LABA)

A

Salmeterol

50
Q

When should LABA be used in the management of asthma

A

When asthma is not controlled with just ICS and LTRA

  • SABA is used as well but that is for symptom relief instead*
  • When adding LABA check whether there is adequate response to LTRA as that can removed if it is not working*
51
Q

Give an example of a Leukotriene receptor antagonist

A

Monteleukast

52
Q

Describe the step wise approach to preventer inhaler asthma therapy regimen

A
  • Used every day to prevent asthma symptoms from occurring.
    • 1st line: Inhaled corticosteroids (ICS)
    • 2nd line: ICS + Leukotriene receptor antagonist (LTRA)
    • 3rd line: ICS + Long acting beta agonist (LABA) +/- LTRA
    • 4th line: Maintenance and reliver therapy (MART) +/- LTRA
53
Q

How is Leukotriene receptor antagonists given

A

Oral tablet

54
Q

When during the asthma preventer inhaler step wise regimen is leukotriene receptor antagonists added

A

Added if there asthma is not controlled with ICS alone

55
Q

What is the first step of preventer inhaler regimen in managing asthma

A

Inhaled corticosteroids (ICS)

Alongside SABA (For symptom relief)

56
Q

What is the second step of preventer inhaler regimen in managing asthma

A

Inhaled corticosteroids (ICS) + Leukotriene receptor antagonist (LTRA)

Alongside SABA (For symptom relief)

57
Q

What is the third step of preventer inhaler regimen in managing asthma

A

Inhaled corticosteroids (ICS) + Long acting beta agonist (LABA) +/- Leukotriene receptor antagonist (LTRA)

Alongside SABA (For symptom relief)

Only continue LTRA if they are responsive to it. Otherwise remove.

58
Q

What is the fourth step of preventer inhaler regimen in managing asthma

A

Maintenance and reliver therapy (MART) +/- Leukotriene receptor antagonist (LTRA)

Alongside SABA (For symptom relief)

Only continue LTRA if they are responsive to it. Otherwise remove.

59
Q

Give an example of a Maintenance and reliever therapy (MART)

[managing chronic asthma]

A

Turbohaler

60
Q

What is Maintenance and reliever therapy (MART)

A

Combination of ICS and fasting-acting LABA

61
Q

Define acute asthma

A

It is an acute episode of worsening asthma exacerbation

Characterised by worsening dyspnoea, wheeze and cough that is not responding to salbutamol

Medical emergency

62
Q

Acute asthma is categoried into 4 categories.

Name them

A

Moderate

Severe

Life-threatening

Near-fatal

63
Q

What is the peak expiratory flow rate (PEFR) that would categories someone in the moderate acute asthma class

A

PEFR 50-75% best or predicted

64
Q

What is the peak expiratory flow rate (PEFR) that would categories someone in the severe acute asthma class

A

PEFR 33-50% best or predicted

65
Q

What is the peak expiratory flow rate (PEFR) that would categories someone in the life threatening acute asthma class

A

PEFR <33% best or predicted

66
Q

What are the 4 medications used in the initial management of acute asthma

A

SABA nebules e.g. salbutamol, terbutaline

LAMA (long acting muscarinic antagonist) nebules e.g. Ipratropium

Oxygen (if hypoxaemic)

Steroids (either oral prednisolone or IV hydrocortisone)

67
Q

Give two example of SABA nedules that can be used in the initial treatment of acute asthma

A

Salbutamol and Terbutaline

68
Q

How does SABA nedules help in the initial treatment of acute asthma

A

Relieves bronchospasm

69
Q

SABA is used in the initial treatment of acute asthma.

What two ways can it be given

A

Metered-dose inhaler or nebuliser

70
Q

Give an example of LAMA nedules that can be used in the initial treatment of acute asthma

A

LAMA - Long acting muscarinic antagonist

Ipratropium

71
Q

How does LAMA nedules help in the initial management of acute asthma

A

Combining nebulised ipratropium bromide with a nebulised β2 agonist produces significantly greater bronchodilation than β2 agonist alone, leading to faster recovery and shorter duration of admission.

72
Q

In what patients group should oxygen be used in the initial management of acute asthma

A

Used in patient is hypoxaemic (common in acute asthma)

73
Q

What is the maintenance target for oxygen in patient suffering from acute asthma attack

A

SpO2 level of 94–98%

74
Q

Give an example of an oral steroid that is used as part of the initial management of acute asthma attack.

A

oral prednisolone

75
Q

Give an example of an IV steroid that is used as part of the initial management of acute asthma attack.

A

IV hydrocortisone

76
Q

How long should steroids be used in the management of acute asthma attack

A

Continue until recovery (minimum 5 days)

In cases where IV hydrocortisone has been used, switch to oral prednisolone when appropriate

77
Q

Second line therapies are used in patient who do not improve after 15 minutes of initial treatment or if there are life threatening features present.

Name two second line therapies

A

IV magnesium sulphate

IV aminophylline (only following consultation with senior clinicians)

Referral to senior clinicians are ICU team for intubation and ventilation

78
Q

Describe how IV mangesium sulphate is used as a second line therapy for acute asthma attack

A

Single dose

Evidence to suggest magnesium sulphate has bronchodilator effects.

79
Q

Name the two types of Positive airway pressure (PAP)

A

BiPAP and CPAP

80
Q

In what type of respiratory failure is BiPAP used and how does it help?

A

Bi-level positive airway pressure

Delivers higher air pressure during inspiration

Useful for remove CO2 retention and thus Type 2 respiratory failure

81
Q

In what type of respiratory failure is CPAP used and how does it help?

A

Continuous positive airway pressure

Delivers same air pressure in inspiration and expiration

Useful for Type 1 respiratory failure

82
Q
A
83
Q

COPD vs Asthma:

What age is it seen in

A

COPD: over 35s

Asthma: Any age

84
Q

COPD vs Asthma:

Which one does dyspnoea varies

A

Asthma - usually acute episodes of exacerbation

COPD it is do not vary much

85
Q

COPD vs Asthma:

Which one is dyspnoea common at rest

A

Asthma

86
Q

COPD vs Asthma:

Which one is associated with a smoking history

A

COPD definitively

In asthma it could be a trigger but it has variable association

87
Q

COPD vs Asthma:

Which one has commonly a morning cough

A

COPD

88
Q

COPD vs Asthma:

Which one is commonly a noctural cough

A

Asthma

89
Q

COPD vs Asthma:

Which one has a family history of the condition as a risk factor

A

Asthma

90
Q

COPD vs Asthma:

Which one is commonly associated with atopy

A

Asthma

Finals: Medicine (91 decks)

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