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Asthma Flashcards

1
Q

Define Asthma

A

Disease characterised by:

Increased responsiveness of trachea & bronchi to various stimuli

Manifested by:

Widespread narrowing of airways that changes in severity either spontaneously or due to therapy

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2
Q

How does asthma cause the airways to narrow?

A

Inflammation of airway:
- Directly narrows airway
- Increases airway reactivity/irritability, results in spontaneous or stimulus driven airway narrowing

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3
Q

How many people does asthma kill a year?

A

Around 1000

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4
Q

How many people are recieveing asthma treatment in the UK?

A

5.4 million
10-15% of kids and 5-10% adults

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5
Q

How many hospital admissions are astham related?

A

67000 + 4.1million GP consulatations

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6
Q

How much money is spent on asthma?

A

~2.3billion a year

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7
Q

List the proven risk factors for asthma?

A
  • Atopy
  • Occupation
  • Smoking
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8
Q

Define atopy

A

An inherited tendency to produce IgE in response to allergen

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9
Q

What kind of conditions can becaused by atopy?

A
  • Asthma
  • Eczema
  • Hay-fever
  • Food Allergies
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10
Q

How do we test for atopy?

A
  • Markers
  • Skin prick test (place allergen under skin)
  • IgE tests
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11
Q

What kind of inheritance has the main effect on atopy?

A

MAternal inheritence is 3x as influential as paternal inheritance when it comes to determining atopy

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12
Q

What kind of genes show association with atopy?

A
  • Immune response genes (Il-4, IL-5, IgE)
  • Airway genes (ADAM33)
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13
Q

What sort of allergens are known to be related to asthma?

A

House dust mite dropppings
Cat allergens

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14
Q

How are exposure and atopy relateD?

A

Exposure doesnt cause atopy or asthma.

once someone atopic is sensitized to an allergen it can trigger an asthmatic response.

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15
Q

How much of asthma is occupational?

A

Around 10-15% of adult onset asthma is occupational

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16
Q

What types of occupations can cause asthma?

A

Bakers - Grains
Lab workers - Rodent urine
Painters - PAint
Chefs/fishermen - Crustaceans

17
Q

What happens to a child whose mother smokes in pregnancY?

A

They can develop:
- Lower FEV1
- Wheezy illness
- A greater airway responsiveness
- Greater chance & severity of asthma

18
Q

What is the grandmother effect?

A

A child will be twice as likely to develop asthma if their grandma smoked during pregnancy (it skips a generation).
Also 1.5x more likley if their mum did and 2.5 times if both did.

19
Q

How are airway obstructions related to astgma?

A

Someone with a localized airway obstruction like a tumour or foreign body can appear to have asthma.

20
Q

What symptoms are we looking for in a history to diagnose asthma?

A
  • Wheeze
  • Short of breath (dyspnoea)
  • Chest tightness & pain
  • Cough (paroxysmal, sudden)
  • occasional sputum
21
Q

Why is simply seeing the symptoms not enough to diagnose asthma?

A

Theyre the same symptoms as any other respiratory disease

22
Q

What beyond the symptoms do we look for to diagnose asthma?

A

The variability of the symptoms. Only is asthma are the symptoms mixed up and variable with time/location.

23
Q

What kind of variability is there in asthma symptoms?

A

The symptoms can be varied due to trigers like exercisem cold air, smoke, pets or a job.
They can also vary in time such as at day or night or weekends or holidays or even seasons.

24
Q

What other conditions do we look for in a hisotry to denote asthma?

A

Other atopic conditions like eczema or hayfever

25
Q

What do we look for in family and social history?

A
  • Families atopic disease
  • Smoking
  • Pets
  • Occupations
  • Psychosocial stresses
26
Q

What drugs can worsen asthma?

A

B-blockers
Aspirin
NSAIDS

27
Q

What should we cheack if someone already has asthma?

A

Compliance and technique with inhalers

28
Q

How useful is examination in asthma diagnosis?

A

Not much as theyre not always having symptoms.
Can rule out asthma sometimes if another conditions can be seen

29
Q

What kind of investigations can we do to determine asthma?

A
  • Spirometry
  • Testing with treatment
  • Pulmonary function tests
  • Peak flow monitoring
  • Specialist investigations
30
Q

How is dynamic spirometry used?

A

An FEV1/FVC is taken during symptoms and if the ratio is abnormally low (<80%) this show a generalised airway obstruction

31
Q

How do we use a pulmonary function test?

A

If an obstruction is found a full pulmonary function test is done which will rule out COPD/Emphysema

32
Q

What makes up a full pulmonary function test?

A
  • Lung volume is tested using gas trapping with helium which tells us Residual volume and Total lung capacity
  • Gas transfer rate of Carbon Monoxide is used to determine that thers no tissue destruction.
33
Q

How do we test with treatment?

A

If spirometry shows obstruction and pulmonary function tests rule out COPD/emphysema then a bronchodilator like salbutamol is used. Failing that a course of oral corticosteroids.

34
Q

What do we use to determine occupational asthma?

A

Serial peak flow readings every 2 hours for atelast 5 days to see if symptoms worsen at work.

35
Q

What kind of specialist investigations do we use?

A
  • Airway responsiveness to methacholine
  • Exhaled Nitric Oxide
36
Q

What do we use a chest X-ray for?

A

A chest X-Ray excludes other conditions

37
Q

What kind of parameters are used to measure asthma severity?

A
  • Ability to speak
  • How high the heart rate is
  • How fast the respiratory rate is
  • The PaO2 and SaO2
  • Any impaired consciousness, confusion or exhaustion
38
Q

What are the biggest indicators of asthma in a child?

A
  • SOB @ rest
  • Personal/parental hisotry of atopic illness
  • Wheeze (not rattle or stridor)
  • variable symptoms
  • Much more in boys than girls
39
Q

Why arnt peak flows and prick tests used in kids?

A

Too many kids have variable peak flows without asthma.
Lots of kids are allergic without having asthma as a symptom.

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