Asthma Flashcards
list FIVE symptoms of asthma and FIVE risk factors
Symptoms
Wheeze
- Breathlessness
- Cough (occasionally)
- Daily or seasonal variation
- Chest tightness
Risk factors
-A family history of asthma /allergic conditions
* Bronchiolitis as a child
* Exposure to tobacco smoke
* Being born prematurely
* Type of job/occupational exposures
what factors can trigger asthma
- Pollen
- Food
- Drugs
- House dust mites
- Moulds & fungi
- Tobacco smoke
- Air pollution
- cold and viral infection
- Stress or emotion
Describe pathogenesis of asthma
1) Allergens interact with respiratory mucosa
2) trigger IgE-mediated mast cell response
3) Activation of mast cells causes them to degranulate
4) and release various proinflammatory mediators such as Histamine, Leukotrienes and cytokines
5) which attract and recruit further inflammatory response cells such as eosinophils, monocytes and T cells.
6) These cells also secrete mediators which amplifies the inflammatory response
7) The overall effect is narrowing of small airways by bronchospasm
Explain the following test used to DIAGNOSE asthma and provide rational for each
a) Airway Inflammation Measurement
b) Lung function test
c)Airway hyperreactivity measurement
- Airway inflammation measurement
- Measure Fractional exhaled Nitric Oxide in the breath (FeNO).
In adult asthmatic patients there is evidence of increased expression of NOS2 in airway epithelial cells- Patients with asthma caused by allergic airway inflammation have high levels of FeNO.
POSITIVE TEST:
FeNO level of 40 parts per billion (ppb) or more (adult)
Rationale for this test:
Confirm the presence of inflammation and thus ensure appropriate treatment with anti-inflammatory medications, especially corticosteroids
- Lung function test
- Obstructive spirometry
POSITIVE TEST
FEV1/FVC <70% or below the lower limit of normal.
Rationale for this test:
Measure lung volumes and capacity to determine the presence of an obstructive or a restrictive disease.
- Bronchodilator reversibility (BDR) test
-Spirometry after inhaling short-acting b2 adrenoceptor agonist POSITIVE TEST
An improvement in FEV1 of 12% or more, AND with an increase in volume of 200 ml or more.
Rationale for this test:
Determine the presence of a reversible airways obstruction - Peak flow variability
- Monitor peak flow variability for 2 to 4 weeks
POSITIVE TEST:
More than 20% variability
Rationale for this test:
Determine the presence of daily variability of air peak flow.
- Airway hyperreactivity measurement
- Direct bronchial challenge test (adults only): with histamine or methacholine.
There’s increase sensitivity to asthma patient when they are tested with histamine or methacholine.
POSITIVE TEST
Provocative concentration of methacholine causing a 20% fall in FEV1 (PC20) of 8 mg/ml or less.
Rationale for this test:
Airway hyperresponsiveness is a characteristic feature of asthma and consists of an increased sensitivity of the airways to chemicals, cold air, stimulant drug
Compare Formeterol and salmeterol
they are both LABA. long acting beta 2 agonist. however formoterol has a faster onset while salmeterol has a slower onset
Describe MART therapy and state an advantage
Maintenance and reliever therapy (MART) is a form of combined ICS and LABA treatment in which a single inhaler.
the LABA used in MART is Formoterol because it is fast onset
Advantage
- reduce use of corticosteroid
Describe the role of Beclomethasone and salbutamol in asthma treatment
beclomethasone dipropionate is an inhaled corticosteroid for used as preventer in asthma
salbutamol is a SABA used as reliever
State ONE advantage and ONE disadvantage of Salbutamol
Advantages:
- Reduce of corticosteroid dose
- Reduce symptoms and improve lung function
Disadvantages:
Increase risk of asthma exacerbation, hospitalization, death
Name an example of inhaled, oral and IV glucocorticoid used in asthma and their use
Glucocorticoid
- Inhaled = beclomethasone
- Oral = Prednisolone
- IV = hydrocortisone
List FIVE side effects of glucocorticoids
Glaucoma
Osteoporosis
Weight gain
Infection
changes in mood
peptic ulcer
Discuss non- pharmacological treatment of asthma
Avoid asthma triggers
Ensure ventilation, keep house clean
Regular exercise, maintain a healthy weight,
Relaxation and breathing exercises will help to avoid feelings of panic during an asthma attack.
Describe the purpose of an Asthma Action plan
it is an individualised worksheet that shows you the steps to take to keep your asthma from getting worse.
Provides guidance on when to call your healthcare provider or when to go to the emergency room.
what would you monitor in asthma
oxygen saturation
heartrate
potassuim
blood glucose
Describe how you will counsel an asthma patient
- Explain when and how to use inhalers, demonstrate correct technique for using them
- Preventer vs reliever; importance of using preventer inhaler regularly even when well
- Know when inhaler needs to be changed and how to replace it
- Using a spacer and mouth-rinsing will avoid the most common side effects of ICS
- Provide steroid cards as appropriate and counsel patients on side-effects
- Aware of any asthma triggers (e.g. dust mites, pet hair), how to avoid/ cope with them
- lifestyle advice
