Asthma Flashcards
What is asthma?
A chronic obstructive inflammatory disease that affects both the large and small airways.
Patients will experience episodic bronchoconstriction.
Is asthma progressive?
No.
Does asthma affect the lungs?
No, it affects the airways only.
What are the two main groupings of asthma patients?
Atopic/Extrinsic (most common)
Non-atopic/Intrinsic
What is meant by atopic/extrinsic asthma?
It is caused by an external stimulus (often an allergic reaction).
May co-present with eczema and allergic rhinitis (the ‘atopic triad’). There is a genetic predisposition.
What is meant by non-atopic/intrinsic asthma?
It is caused by an internal stimuli.
What occurs in an asthma attack?
An immediate wave of bronchospasm (type 1 hypersensitivity), followed by a delayed inflammatory process (type 4 hypersensitivity).
What are precipitating factors in non-atopic asthma?
Animal dander
Infection
Cold/Damp conditions
Night/Early mornings
Is the airflow obstruction in asthma reversible?
Yes.
What is a typical presentation of asthma?
Episodic symptoms
Diurnal variability (often worse at night)
Dry cough, wheeze, SOB
Decreased exercise tolerance
Can chronic asthma cause irreversible damage?
Yes - this may result in airway remodelling.
This is characterised by:
Thickening of the basement membrane
Collagen deposition in the submucosa
Hypertrophy of the smooth muscle
How does spirometry show in an asthmatic patient?
They will have reduced expiratory ratio (FEV1/FVC < 70%).
This is reversible by up to 15% upon commencement of salbutamol therapy (only raises FEV1 - FVC remains constant).
What is the first-line for asthma treatment?
SABA and ICS.
What is the second-line for asthma treatment?
SABA and ICS and LABA.
If no response, then remove LABA, and increase ICS dose.
If some response, keep LABA and increase ICS dose.
What is third-line for asthma treatment?
SABA/ICS/LABA, plus one of the following:
LTRA
Theophylline
LAMA
Chromones
What is fourth-line for asthma management?
Refer for specialist care.
Increase ICS dose, maintain SABA and LABA therapy alongside third drug (theophylline, LAMA, LTRA, or chromones), and add another of the following:
Theophylline
Beta-agonist tablet
LAMA
What is the management of an acute exacerbation of asthma?
Think ‘OHSHITMAN’:
Oxygen (atleast 60%)
Salbutamol (nebulised)
Hydrocortisone (IV), or oral prednisolone
Ipratropium (nebulised)
Theophylline (oral)
Magnesium sulphate (IV)
AN anaesthetist (to intubate)
A patient presents with:
PEFR more than 50–75% best or predicted (at least 50% best or predicted in children) and normal speech, with no features of acute severe or life-threatening asthma.
How severe is their asthma attack?
Moderate only.
A patient presents with:
PEFR 33–50% best or predicted, (less than 50% best or predicted in children) or a respiratory rate of at least 25/min in people over the age of 12 years, or pulse rate of at least 110/min in people over the age of 12 years, or inability to complete sentences in one breath, or accessory muscle use, or inability to feed (infants), with oxygen saturation of at least 92%.
How severe is their asthma attack?
Acute severe asthma attack.
A patient presents with:
PEFR less than 33% best or predicted, or oxygen saturation of less than 92%, or altered consciousness, or exhaustion, or cardiac arrhythmia, or hypotension, or cyanosis, or poor respiratory effort, or silent chest, or confusion.
How severe is their asthma attack?
Life-threatening asthma attack.
What is an example of a SABA?
Salbutamol
What are examples of LABAs?
Salmeterol
Formoterol
What may happen if lone LABA therapy is given?
If LABA alone given, can worsen asthma. Therefore, always given alongside an ICS.
What type of drug is theophylline?
A methylxanthine.
This class has many interactions, thus cannot be prescribed alongside CYP450 inhibitors (e.g. ciprofloxacin or amiodarone).
What are examples of steroids used in the management of asthma?
Beclomethasone
Prednisolone
What should be used to deliver ICS, and why?
A spacer.
This drug may cause oropharyngeal candidiasis.
