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4th year passmedicine by topic > Asthma > Flashcards

Asthma Flashcards

1
Q

the most common chronic respiratory disorder

A

asthma

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2
Q

asthma

A

chronic inflammatory disorder of the airways

secondary to type 1 hypersensitivity

variable and recurring symptoms manifest as reversible bronchospasm resulting in airway obstruction.

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3
Q

asthma risk factors

A

atopy

antenatal factors:
- maternal smoking
- maternal viral infection (RSV)

birth factors:
- low birth weight
- not being breastfed

environmental:
- smoke
- allergens (house dust mite)
- air pollution

‘hygiene hypothesis’:

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4
Q

number of patients with asthma are sensitive to?

A

aspirin

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5
Q

patients who are most sensitive to asthma often suffer from?

A

nasal polyps

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6
Q

asthma signs & symptoms

A

symptoms: cough (nocturnal), dyspnoea, wheeze

signs:
auscultation: expiratory wheeze

PEFR (peak expiratory flow rate): reduced

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7
Q

typical spirometry results in asthma?

A

FEV1 - significantly reduced
FVC - normal
FEV1% (FEV1/FVC) < 70%

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8
Q

asthma adults investigations

A

exclude occupational asthma

spirometry + a bronchodilator reversibility (BDR) test

FeNO test

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9
Q

asthma children (5-16 y/o) diagnosis

A

spirometry + a bronchodilator reversibility (BDR) test

FeNO test

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10
Q

asthma children (<5 y/o) diagnosis

A

clinical judgement

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11
Q

FeNo positive test

A

in adults level of >= 40 parts per billion (ppb)

in children a level of >= 35 parts per billion (ppb

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12
Q

what does a reversbility test measure?

A

FEV1

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13
Q

positive reversibility test

A

FEV1 improvement of 12% or more

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14
Q

how does FeNO work?

A

nitric oxide is produced by 3 types of nitric oxide synthases (NOS).

one of the types is inducible (iNOS) and levels tend to rise in inflammatory cells, particularly eosinophils

levels of NO therefore typically correlate with levels of inflammation.

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15
Q

asthma management in adults

A
  1. SABA
  2. SABA + ICS
  3. SABA + ICS + LTRA
  4. SABA + ICS + LABA

continue LTRA depending on patient’s response to LTRA

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16
Q

maintenance and reliever therapy (MART)

A

a form of combined ICS and LABA treatment

a single inhaler (ICS + LABA) used for daily maintenance therapy and the relief of symptoms as required

17
Q

Describe low, moderate and high doses of ICS

A

<= 400 micrograms budesonide or equivalent = low dose

400 micrograms - 800 micrograms budesonide or equivalent = moderate dose

> 800 micrograms budesonide or equivalent= high dose

paeds 200/ 200-400/ >400

18
Q

asthma management in <5

A
  1. SABA
  2. SABA + an 8-week trial of MODERATE-dose inhaled corticosteroid (ICS)
  3. SABA + low-dose ICS + LTRA
  4. Stop the LTRA and refer to an paediatric asthma specialist
19
Q

when should we consider stepping down asthma treatment?

A

every 3 months or so

take into account duration of treatment, side-effects and patient preference

20
Q

when reducing the dose of inhaled steroids the BTS advise us to do this by what increments?

A

25-50%

21
Q

acute asthma features

A

worsening dyspnoea, wheeze and cough that is not responding to salbutamol
maybe triggered by a respiratory tract infection

22
Q

moderate acute asthma

A

PEFR 50-75% best or predicted
Speech normal
Pulse < 110 bpm
RR < 25 / min

PSPR

23
Q

severe acute asthma

A

PEFR 33 - 50% best or predicted
speech: can’t complete sentences
Pulse > 110 bpm
RR > 25/min

PSPR

24
Q

life-threatening acute asthma

A

P - PEFR < 33% best or predicted
S - Exhaustion, confusion or coma
P - Bradycardia, dysrhythmia or hypotension
R - Silent chest, cyanosis or feeble respiratory effort
Oxygen sats < 92%

PSPR

25
Q

normal pCO2 in an acute asthma attack is a good sign

A

FALSE

indicates exhaustion and should, therefore, be classified as life-threatening.

26
Q

near-fatal asthma

A

fourth category

characterised by a raised pC02 and/or requiring mechanical ventilation with raised inflation pressures

27
Q

important step in further assessment of acute asthma?

A

arterial blood gases for patients with oxygen sats < 92%

28
Q

CXR is routinely performed in acute asthma attacks

A

not routinely recommended

unless:
life-threatening asthma
suspected pneumothorax
failure to respond to treatment

29
Q

when should patients be admitted to hopsital?

A

life-threatening asthma

severe acute asthma & fail to respond to initial treatment

previous near-fatal asthma attack

pregnancy

attack despite using oral corticosteroid

presentation at night

30
Q

acute asthma attack management

A

oxygen: 15L of supplemental via a non-rebreathe mask

SABA

hydrocortisone or prednisolone (40-50mg) for at least five days

ipratropium bromide

IV aminophylline

IV magnesium sulphate

ITU/HDU

31
Q

acute asthma attack discharge criteria

A

stable on their discharge medication (no nebulisers or oxygen) for 12–24 hours

inhaler technique checked and recorded

PEF >75% of best or predicted

32
Q

asthma in children: how do you assess acute attacks?

A

severe attack or life-threatening attack

33
Q

severe asthma attack in kids

A

SpO2 < 92%

PEF 33-50% best or predicted

Too breathless to talk or feed

Heart rate
>125 (>5 years)
>140 (1-5 years)

Respiratory rate
>30 breaths/min (>5 years)
>40 (1-5 years)

Use of accessory neck muscles

34
Q

life threatening asthma attack in kids

A

SpO2 <92%

PEF <33% best or predicted

Silent chest

Poor respiratory effort

Agitation

Altered consciousness

Cyanosis

35
Q

chemicals associated with occupational asthma

A

isocyanates - most common cause

spray painting and foam moulding using adhesives
platinum salts

soldering flux resin

glutaraldehyde

flour

epoxy resins

proteolytic enzymes

4th year passmedicine by topic (96 decks)

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