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Asthma Flashcards

1
Q

What happens in asthma?

A

Smooth muscle in the airways is hypersensitive and responds to stimuli by constricting causing airflow obstruction

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2
Q

What might an asthma examination show?

A

Widespread polyphonic expiratory wheeze

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3
Q

What drugs can worsen asthma?

A
  • Beta blockers
  • NSAIDS
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4
Q

What investigations are recommended in patients with suspected asthma?

A
  • Fractional exhaled nitric oxide (FeNO) test
  • Spirometry with bronchodilator reversibility
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5
Q

What is Fractional exhaled nitric oxide testing? What can make the results of this test unreliable?

A
  • Measures the concentration of nitric oxide exhaled
  • Nitric oxide is a marker of airway inflammation
  • A level above 40 ppb is a positive test result
  • Smoking lowers the FeNO making the result unreliable
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6
Q

What does spirometry measure?

A

The volume and flow of air during exhalation and inhalation

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7
Q

What is FEV1?

A
  • Forced expiratory volume
  • Volume exhaled at the end of the first second of forced expiration
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8
Q

What is FVC?

A
  • Forced vital capacity
  • Volume that has been exhaled after a maximal expiration following a full inspiration
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9
Q

What are the typical FEV1, FVC and FEV1/FVC results in asthma?

A
  • FEV1 - significantly reduced
  • FVC - normal
  • FEV1/FVC < 70%
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10
Q

What is used in bronchodilator reversibility testing? What is a positive result?

A
  • Salbutamol
  • An improvement on FEV1 of 12% or more
  • And an increase in volume of 200ml or more
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11
Q

Further investigations if there is diagnostic uncertainty following FeNO testing and spirometry?

A
  • Peak flow diary for 4 weeks - peak flow variability
  • Direct bronchial challenge test with histamine/methacholine - opposite of reversibility testing
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12
Q

What are the NICE guidelines for long term asthma management?

A
  1. SABA (salbutamol)
  2. add low dose ICS
  3. add LTRA (montelukast)
  4. add LABA (+/- LTRA depending on pt response)
  5. Switch to MART (with low dose ICS)
  6. Increase dose of ICS
  7. Specialist management
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13
Q

What colour are SABA inhalers?

A

Blue

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14
Q

What is a side effect of SABA inhalers?

A

Tremer

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15
Q

What are side effects of ICS?

A
  • Oral candidiasis
  • Stunted growth in children
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16
Q

What will arterial blood gas show during an acute asthma exacerbation? What is a concerning sign?

A
  • Respiratory alkalosis as raised resp rate causes a drop in CO2
  • A normal pCO2 or pO2 is a concerning sign as it indicates they are getting tired
17
Q

What peak flow reading would indicate:
1. Moderate asthma exacerbation
2. Severe asthma exacerbation
3. Life threatening asthma exacerbation

A
  1. 50-75% best or predicted
  2. 33-50% best or predicted
  3. <33% best or predicted
18
Q

What signs indicate a moderate acute asthma attack?

A
  • Speech normal
  • RR <25/min
  • Pulse <110bpm
19
Q

What signs indicate a severe acute asthma attack?

A
  • Can’t complete sentences
  • RR >25/min
  • Pulse > 110bpm
20
Q

What signs indicate a life-threatening acute asthma attack?

A
  • Oxygen sats <92%
  • Normal pCO2
  • Silent chest
  • Cyanosis
  • Bradycardia
  • Hypotension
  • Confusion
21
Q

What is ‘silent chest’? What is it a sign of?

A
  • When a wheeze disappears as the airways are so tight that there is no air entry
  • Life threatening asthma exacerbation
22
Q

What is the step-wise management of a mild asthma exacerbation?

A
  1. SABA with spacer
  2. Quadrupled dose of ICS
  3. Oral steroids if insufficient

Follow up within 48 hrs

23
Q

What is the step-wise management of a moderate asthma exacerbation?

A
  1. Nebulised SABA
  2. Steriods - oral prednisone/IV hydrocortisone
24
Q

What is the step-wise management of a severe/life-threatening asthma exacerbation?

A

Oxygen to maintain sats 94-98%

  1. Nebulised SABA
  2. Steriods - oral prednisone/IV hydrocortisone

May be additional treated with:
- Nebulised ipratropium bromide (SAMA)
- IV magnesium sulphate
- IV salbutamol
- IV aminophylline

25
Q

What are complications of salbutamol treatment?

A
  • Hypokalemia (salbutamol drives K+ into cells)
  • Tachycardia
  • Lactic acidosis
26
Q

What is the MOA of salbutamol?

A
  • Beta-2 adrenergic receptor agonist
  • Relaxes bronchial smooth muscle through effects on beta 2 receptors
27
Q

What is the MAO of LAMA?

A
  • E.g. tiotropium
  • Long-acting muscarinic antagonist
  • Block ACh receptors
  • ACh receptors are stimulated by the parasympathetic nervous system and cause contraction of the bronchial smooth muscle
28
Q

What is the role of ICS in asthma management?

A

Reduce inflammation and the reactivity of the airways

29
Q

What is the MOA of LTRAs?

A
  • E.g. montelukast
  • Leukotriene receptor antagonists
  • Block the effect of leukotrienes
  • Leukotrienes are produced the immune system and cause inflammation, bronchoconstriction and mucus secretion in the airways
30
Q

What is the criteria for discharge following an acute asthma attack?

A
  • Stable on discharge meds for 12-24 hrs
  • Inhaler technique checked and recorded
  • PEF >75% best or predicted

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