Asthma Flashcards
What is the atopic triad?
The tendency for eczema, asthma and allergic rhinitis to occur together in a patient. Usually it begins with a young child/ baby developing eczema which then develops into food allergies before developing into allergic rhinitis and asthma.
What age are most children diagnosed with asthma?
Usually symptoms begin to appear by the age of five
What are some of the causes of asthma?
Genetic history
Enivronmental (dust, pollen)
Allergens
Hygiene hypothesis (reduced exposure to allergens may develop late-onset asthma)
Cold
Exercise
Pet hairs
What are the early stage inflammatory responses of asthma?
Bronchoconstriction
Vasodilation
Hypersecretion
Hypersensitivity
Increased vascular permeability
Muscosal inflammation
What are some of the late stage inflammatory responses of asthma?
Damage to the upper epithelium
Damage to the cilia
Cellular infiltration
Bronchoconstriction
What are the key clinical symptoms of asthma?
Wheezing
Shortness of breath
Chest tightening
Dry cough
Diurnal variation (symptoms usually present in the morning or late at night)
Episodic attacks
How is asthma diagnosed?
Usually based on clinical symptoms
History of atopy
Diurnal variation
Triggers
Recurrent
Plus a spirometry/ peak flow tests. Usually a significant improvement of spirometry result after bronchodilator is introduced.
If a patient only presented some of the asthma symptoms, what would the diagnostic outcome be?
If only some clinical symptoms are present, take peak flow and spirometry readings and then introduce a ICS for a couple of weeks. If there is steroid responsiveness then start treatment according to asthma guidelines.
What is the initial treatment for asthma?
Reliever therapy: bronchodilator (B2-agonist) to relieve symptoms during an attack
Preventer therapy: low dose inhaled corticosteroid to be taken every day
When would you consider moving a patient up the asthma treatment stages?
If they are using their reliever therapies more than 3 times a week
When is a LABA introduced?
It is the initial add on therapy to a SABA + ICS
What are the three possible treatment outcomes at the additional add on therapy stage?
No responsive to LABA- STOP
Response to LABA but still insufficient- increase to a medium dose of ICS or introduce fourth inhaler (LTRA, theophylline etc)
What are the two high dose therapies?
High dose of ICS
Addition of fourth drug
When would you consider moving a patient down the treatment ladder?
No symptoms present in the last 6 months
What sort of things would you discuss with a patient before moving them up the treatment ladder?
Inhaler technique
Adherence
Trying to eliminate any possible triggers
