Asthma Flashcards
What characteristic of asthma must a patient have?
A wheeze
NO WHEEZE, NO ASTHMA
What is asthma?
- literally “panting”
- chronic
- wheeze, cough, SOB (dyspnoea)
- multiple triggers
- variable/reversible
- responds to asthma Rx
- occasional sputum
What is the WHO definition of asthma?
Asthma attacks all age groups but often starts in childhood. It is a disease characterised by recurrent attacks of breathlessness and wheezing, which vary in severity and frequency from person to person. In an individual, they may occur from hour to hour and day to day.
What causes asthma?
1.) host response to environment
2.) infection important
3.) physiology abnormal before symptoms
4.) it is a syndrome
What are the different settings of asthma?
1.) infant onset
2.) childhood onset
3.) adult onset
4.) excertional asthma
5.) occupational asthma
How do you tell if it is asthma?
Through the history
What is the diagnostic asthma test in children?
There is none :)
What are the characteristics of an asthmatic cough?
- dry
- nocturnal (just after falling asleep)
- exertional
- paroxysmal
What is the basic treatment for asthma?
ICS for 2 months
What are differential diagnosis for “asthma” in under 5 years?
- congenital
- CF
- PCD
- bronchitis
- foreign body
What are differential diagnosis for “asthma” in over 5 years?
- dysfunctional breathing
- vocal cord dysfunction
- habitual cough
- pertussis
What does SANE stand for?
Short acting beta agonist/week
Absence school/nursery
Nocturnal symptoms/week
Excertional symptoms/week
What is the step up step down approach?
Start on low does ICS
- severe asthma may respond to minimal treatment
Review after 2 months
- no routine test to monitor progress
- no change easier than down
- need an inhaler holiday (easter)
What are the different classes of medications?
- short acting beta agonists
- inhaled corticosteroids (ICS)
- oral steroids
“add ons”
- long acting beta agonists
- leukotriene receptor antagonists
- theophyllines
When do you use a regular preventer?
- symptomatic three times a week or more, or waking one night (exacerbations of asthma in the last two years)
- B2 agonists more than 2 days a week
What do you use as a regular preventor?
Very low does inhaled corticosteroids (or LTRA in <5s)
What are the initial add on preventer for when it gets complicated?
- add on LABA or LTRA (BTS/SIGN)
- add on LTRA (NICE)
- increase ICS dose (GINA)
What are the two types of delivery systems?
- MDI/spacer
- dry powder device
Whats the age ranges for dry powder devices?
Licensed in over 5s, under 8s cannot use them
What are other forms of management for asthma?
- stop tobacco smoke exposure
- remove environmental triggers (cat, dog etc)
How do you choose what form of management to use for asthma?
- resp rate
- work of breathing
- heart rate
- ox sat
- ability to complete sentences
- confusion
- air entry
How long do you wait to reassess after starting treatment?
1 hour, then proceed with step up or step down as appropriate
What steroids are used for chronic/maintenance treatment?
Inhaled steroids (NOT oral steroids)
What steroids are used for acute treatment?
Oral steroids (NOT inhaled steroids)
Basic definition of asthma?
A disease characterised by an increased responsivenesss of the trachea and bronchi to various stimuli and manifested by a widespread narrowing of airways that changes in severity either spontaneously or as a result of therapy
What happens to the airways during an asthma attack?
- wall inflamed and thickened
- tightened smooth muscles
- air trapped in alevoli
What is atopy?
The body’s predisposition to develop an antibody called immunoglobulin E (IgE) in response to exposure to environmental allergens and is an inheritable trait.
What is atopy associated with?
- allergic rhinitis
- asthma
- hay fever
- eczema
What are examples of variable symptoms?
- daily variation (nocturnal/early morning)
- weekly variation (occupation, better at weekends & holidays)
- annual variation (environmental allergens)
What are useful investigations?
chest x-ray - hyperinflated, hyperlucent (no effusion, collapse, opacities, interstitial changes)
skin prick testing (atopic status)
total and specific IgE (atopic status)
full blood count - eosinophilia (atopy)
What are the symptoms of moderate asthma?
- able to speak, complete sentences
- HR < 110
- RR < 25
- PEF 50-75% predicted or best
- SaO2 > or equal to 92% (no need for ABG)
- PaO2 > or equal to 8kPa
What are the symptoms of severe asthma?
Any one of:
- inability to complete sentences in one breath
- HR > or equal to 110
- RR > or equal to 25
- PEF 33-50% predicted or best
- SaO2 > or equal to 92%
- Pa O2 > or equal to 8kPa
What are the symptoms of life threatening asthma?
Any one of:
- grunting
- impaired consciousness, confusion, exhaustion
- brachicardia/arrhythmia/hypotension
- PEF < 33% predicted or best
- cyanosis
- silent chest
- poor respiratory effort
- SaO2 < 92% (defo needs blood gas!)
- PaO2 < 8kPa
- PaCO2 normal (4.6-6.0kPa)
What are symptoms of near fatal asthma?
- raised PaCO2
- need for mechanical ventilation
Why are inhalers good?
- delivery directly to the target organ (airways and lung)
- onset of effect is faster
- minimal systemic exposure
- systemic adverse effects are less severe and less frequent
What are the different types of SABA relievers?
Salbutamol (MDI and DPI) and Terbutaline (DPI)
What are the different types of pharmacological management?
- inhaled therapy
- oral therapy
- specialist treatments
What are the different types of oral therapy?
- leukotriene receptor antagonist
- theophylline
- prednisolone
How to treat a mild/moderate acute asthma attack?
- increase inhaler use
- oral steroid
- treat trigger
- early follow up
- back up plan
How to treat a moderate/severe acute asthma attack? (in hospital)
Nebulisers - salbutamol/ipratopium
Oral/IV steroid
Magnesium
Aminophylline
Triggers - infection/allergen
Complications - CXR
Review
Level 2/3 care
