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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?

A

Tremor

25
Q

Side effects of ICS?

A

Stunted growth in children
Oral candidiasis

26
Q

Examples of ICS?

A

Beclometasone dipropionate fluticasone and propionate

27
Q

Children under 17 should have which tests?

A

Spirometry with bronchodilator reversibility. If negative then FeNO

28
Q

When is FeNO positive?

A

Adults>=40 parts per billion and in children 35 parts per billion

29
Q

Reversibility testing?

A

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
Q

What is difference in low dose, moderate and high ICS?

A

Less than 400 micrograms, 400-800, more than 800

31
Q

How to reduce dose of inhaled steroids?

A

25-50% at a time

32
Q

How often should you consider stepping down?

A

3 months

33
Q

Presentation of acute asthma

A

Progressively worsening sob
Accessory muscles
Tachypnoea
Symmetrical expiratory wheeze
Tight chest with reduced air entry

34
Q

Moderate grading of acute asthma?

A

PEFR 50-75

35
Q

Severe grading of Acute asthma?

A

PEFR 33-50
Resp rate>25
Heart rate>110
Unable to complete full sentences

36
Q

Life threatening acute asthma?

A

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
Q

How to treat moderate acute asthma?

A

Nebuliser beta 2 agonist- salbutamol 5mg
Nebuliser ipratoprium bromide
Steroids- oral prednisolone and IV hydrocortisone- 5days
Antibiotic if infection

38
Q

Treatment for severe acute asthma?

A

Oxygen to maintain sats
Aminophylline infusion
IV salbutamol

39
Q

Life threatening acute asthma treatment?

A

IV magnesium sulphate infusion
HDU/ICU
Intubation

40
Q

ABGs in asthma?

A

Respiratory alkalosis blowing CO2 off, if tiring hypoxia and normal CO2- life threatening asthma. Respiratory acidosis- high CO2 very bad sign

41
Q

What should you monitor when giving salbutamol?

A

Serum potassium- absorbed into cells. Can cause tachycardia.

42
Q

When do you refer to specialist?

A

If more than 2 attacks in 12 months

43
Q

What is near fatal asthma?

A

Raised CO2 or requiring mechanical ventilation with raised inflation pressures

44
Q

When to do ABG?

A

Sats less than 92

45
Q

When to do CXR?

A

Life threatening asthma, suspected pneumothorax, failure to respond to treatment

46
Q

Criteria for discharge?

A

No oxygen or nebulisers for 12-24 hours
PEF more than 75
Inhaler technique checked

47
Q

ITU/HDU treatment options?

A

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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