asthma

Question 1

RF asthma

Answer 1

atopy // maternal smoking, viral infetion // low BW // bottle fed // air pollution // dust house // too hygienic

Question 2

type of hypersensitivity in asthma

Answer 2

type I IgE

Question 3

inflam response asthma

Answer 3

TH2 response –> B cells –> mast cells + eosinophils –> leukotrienes + histamine + chemokines + IgE

Question 4

what is asthma airway remodelling

Answer 4

Chronic airway inflammation –> fixed obstruction –> basement membrane thickens + submucosa collagen + smooth muscle hypertrophy

Question 5

what is samters triad

Answer 5

asthma + nasal polyps + aspirin sensitivity

Question 6

asthma symptoms

Answer 6

childhood presentation // cough worse at night // SOB // wheeze + tight chest // reduced PEFR

Question 7

common chemicals with occupational asthma

Answer 7

isocyanates (spray painting) // platinum, soldering, flour, epoxy

Question 8

invx occupation asthma

Answer 8

peak flow at work and away from work –> refer to specialist

Question 9

diagnostic tests asthma >17

Answer 9

spirometry with bronchodilator reversibility (BDR) + FeNO

Question 10

diagnostic test asthma 5-16

Answer 10

spirometry + BDR // if normal –> FeNO

Question 11

diagnosis asthma <5

Answer 11

clinical grounds

Question 12

what FeNO indicates asthma

Answer 12

> 40 adults, >35 kids

Question 13

what spirometry indicates asthma

Answer 13

reduced FEV1, normal FVC –> FEV1/FVC <70%

Question 14

results of BDR asthma

Answer 14

improvement >12%

Question 15

asthma mx steps adults (7)

Answer 15

1 = SABA + low ICS // 2 = SABA + low ICS + LTRA // 3 = SABA + low ICS + LABA // 4 = SABA + low ICS MART // 5 = SABA + medium ICS MART OR fixed medium ICS + LABA // 6 = SABA + high dose ICS OR theophylinne OR seek help

Question 16

what happens to LTRA mx in asthma

Answer 16

if good response continue it at all stages

Question 17

what is MART

Answer 17

ICS + LABA inhaler

Question 18

what steroid is a low ICS

Answer 18

400 microg budesonide

Question 19

what steroid is a moderate ICS

Answer 19

400 - 800 micrograms

Question 20

what steroid is a high dose ICS

Answer 20

> 800 micrograms

Question 21

when should stepping down asthma be considered

Answer 21

every 3 months if good control // steroids 25-50% at a time

Question 22

inhaler technique

Answer 22

remove cap + shake –> breathe out –> breathe in slowly + press canister –> hold 10 seconds

Question 23

how long before a second dose inhaler can be given

Answer 23

wait 30 seconds

Question 24

features moderate asthma attack

Answer 24

PEFR 50-75% // RR <25 // HR <100

Question 25

features severe acute asthma

Answer 25

PEFR 33-50% // cant complete sentence // RR >25 // HR >100

Question 26

features life threatening asthma

Answer 26

PEFR <33% // O2 <92% // silent chest, cyanosis // low HR, low BP, dysthyrmia // reduced LOC // normal pCO2

Question 27

when is ABG done in asthma attack

Answer 27

O2 sats <92%

Question 28

when to admit asthma

Answer 28

life threatening // not responding to treatment // previous near fatal // pregnant

Question 29

O2 targets asthma attack

Answer 29

94-98%

Question 30

mx acute asthma

Answer 30

(O shit man) O2 // neb SABA // steroids // ipratropium // mag sulphate // IV aminophylline + anaesthetics

Question 31

dose steroids asthma attach

Answer 31

40-50mg prednisolone PO

Question 32

criteria for discharge asthma attack

Answer 32

stable (no O2 or nebs 12-24 hours) // good inhaler technique // PEFR >75%