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Respiratory > Asthma > Flashcards

Asthma Flashcards

1
Q

What is asthma?

A

Reversible airway obstruction which responds to bronchodilators such as salbutamol

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2
Q

Typical triggers of asthma?

A

Cold, infection, night time or early morning, exercise, animals, dust and strong emotions

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3
Q

Presentation suggesting asthma?

A

Episodic symptoms, diurnal variability, dry cough with wheeze and sob, history of atopic conditions eczema and hay fever, family history, bilateral widespread polyphonic wheeze

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4
Q

What indicates a viral induced condition?

A

Wheeze related to cough and cold

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5
Q

What does unilateral wheeze suggest?

A

Focal lesion or infection

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6
Q

First line investigations for asthma?

A

Fractional exhaled nitric oxide
Spirometry with bronchodilator reversibility

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7
Q

If after first line investigations there is uncertainty then use?

A

Peak flow variability 2-4 weeks
Direct bronchial challenge test with histamine or methacholine

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8
Q

Which are the reliever or rescue medication?

A

SABA- Adrenalin acts on smooth muscle causing dilation

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9
Q

Which are the maintenance or preventer medications?

A

ICS beclometasone

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10
Q

How do LAMA work?

A

Block acetylcholine receptors, which are stimulated by parasympathetic nervous system causing contraction

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11
Q

What do leukotrienes cause?

A

Inflammation, bronchoconstriction and mucus secretion

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12
Q

Theophylline mechanism and important point?

A

Relaxes bronchial smooth muscle and reduces inflammation.
Narrow therapeutic index toxic in excess, monitor 5 days after starting and 3 days after dose change

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13
Q

What is MART?

A

ICS and fast acting LABA

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14
Q

Order of drugs?

A
  1. SABA
  2. ICS
  3. LTRA
    4.LABA
  4. MART
  5. ICS to moderate dose
  6. ICS to high dose or LAMA or oral theophylline
  7. Specialist
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15
Q

How many people die with asthma every year in UK?

A

1000

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16
Q

What type of hypersensitivity is asthma?

A

1

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17
Q

What is the predominant response?

A

Th2

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18
Q

How is occupational asthma diagnosed?

A

Reduced peak flows during week and weekend

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19
Q

Occupational allergens include?

A

Flour and isocyanates (spray painting and foam moulding), platinum salts, resin, gluteraldehyde, proteolytic enzymes

20
Q

Symptoms of asthma?

A

Cough, sob and wheeze/ chest tightness

21
Q

Signs of asthma?

A

Expiratory wheeze on auscultation
Reduced PEFR

22
Q

Spirometry results in asthma?

A

FEV1 Reduced, FVC normal and FEV1% less than 70

23
Q

Why do FENO test?

A

Nitric oxide produced by 3 synthase, one which is inducible and levels tend to rise inflammatory cells (eosinophils)

24
Q

Side effect of salbutamol?

25
Side effects of ICS?
Stunted growth in children Oral candidiasis
26
Examples of ICS?
Beclometasone dipropionate fluticasone and propionate
27
Children under 17 should have which tests?
Spirometry with bronchodilator reversibility. If negative then FeNO
28
When is FeNO positive?
Adults>=40 parts per billion and in children 35 parts per billion
29
Reversibility testing?
Improvement in FEV1 of 12% or more and increase in volume of 200ml in adults In children, improvement in FEV1 of more than 12%
30
What is difference in low dose, moderate and high ICS?
Less than 400 micrograms, 400-800, more than 800
31
How to reduce dose of inhaled steroids?
25-50% at a time
32
How often should you consider stepping down?
3 months
33
Presentation of acute asthma
Progressively worsening sob Accessory muscles Tachypnoea Symmetrical expiratory wheeze Tight chest with reduced air entry
34
Moderate grading of acute asthma?
PEFR 50-75
35
Severe grading of Acute asthma?
PEFR 33-50 Resp rate>25 Heart rate>110 Unable to complete full sentences
36
Life threatening acute asthma?
PEFR less than 33 Sats less than 92 Becoming tired No wheeze- silent chest Haemodynamically unstable- shock Bradycardia dysrhythmia or hypotension Exhaustion, confusion or coma
37
How to treat moderate acute asthma?
Nebuliser beta 2 agonist- salbutamol 5mg Nebuliser ipratoprium bromide Steroids- oral prednisolone and IV hydrocortisone- 5days Antibiotic if infection
38
Treatment for severe acute asthma?
Oxygen to maintain sats Aminophylline infusion IV salbutamol
39
Life threatening acute asthma treatment?
IV magnesium sulphate infusion HDU/ICU Intubation
40
ABGs in asthma?
Respiratory alkalosis blowing CO2 off, if tiring hypoxia and normal CO2- life threatening asthma. Respiratory acidosis- high CO2 very bad sign
41
What should you monitor when giving salbutamol?
Serum potassium- absorbed into cells. Can cause tachycardia.
42
When do you refer to specialist?
If more than 2 attacks in 12 months
43
What is near fatal asthma?
Raised CO2 or requiring mechanical ventilation with raised inflation pressures
44
When to do ABG?
Sats less than 92
45
When to do CXR?
Life threatening asthma, suspected pneumothorax, failure to respond to treatment
46
Criteria for discharge?
No oxygen or nebulisers for 12-24 hours PEF more than 75 Inhaler technique checked
47
ITU/HDU treatment options?
Intubation and ventilate ECMO- blood pumped outside body to machine which removes CO2 and puts oxygen into blood

Respiratory (14 decks)

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