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Phase 4 - Respiratory > Asthma > Flashcards

Asthma Flashcards

1
Q

What is Asthma?

A

Chronic inflammatory condition of the airways secondary to type 1 hypersensitivity due to exposure to allergens. It results in reversible airway obstruction.

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2
Q

What are the risk factors for asthma?

A

Family history,
Personal history of atopy,
Antenatal factors: Maternal smoking, viral infection,
Low birth weight,
Maternal smoking,
air pollution,
High concs of allergens

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3
Q

What is the triad of atopy?

A

Allergic rhinitis (hayfever),
Atopic dermatitis,
Asthma
All IgE mediated atopic conditions

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4
Q

What are the symptoms of asthma?

A

Wheeze, cough, yellow/clear sputum, breathlessness, chest tightness and exercise intolerance.
Symptoms are episodic, diurnal, variable and can be triggered by exercise, allergies, and chemicals. May be worsen by NSAIDs/beta blockers

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5
Q

What are the signs of asthma?

A

Tachypnoea, hyperinflated chest, hyper-resonant percussion, reduced air entry, wheeze

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6
Q

What is the diagnostic testing for asthma?

A

Patients aged 17+: Peak flow diary, all get spirometry with bronchodilator reversibility and all get FeNO test.
Children 5-16 years: Spirometry with bronchodilator reversibility test. FeNO should be done if normal spirometry or negative reversibility.
Children <5 years: Clinical judgement

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7
Q

What is a positive reversibility testing?

A

Adults - Improvement in FEV1 of 12%+ or increase in volume by 200ml
Children - Improvement of FEV1 by 12+%

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8
Q

What is the management of asthma?

A
  1. SABA
  2. If needing to use SABA more than 3x week then Add ICS
  3. SABA, ICS and leukotriene receptor antagonist (montelukast)
  4. SABA, ICD, LTRA (if responded) and LABA
  5. SABA + ICS +/- LTRA MART
  6. Increase ICS (not as MART), theopylline or referral
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9
Q

What is MART?

A

Maintenance and reliever therapy. Contained ICS and LABA

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10
Q

What is a low, moderate or high dose of ICS?

A

Low = <400micrograms budesonide
Moderate = 400-800 micrograms of budesonide.
high = >800 micrograms of budesonide

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11
Q

When should asthma treatment be stepped down?

A

Every three months

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12
Q

What are some conditions which mimic asthma?

A

GORD
Eosinophilic granulomatosis with polyangiitis
Alergic bronchopulmonary aspergillosis

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13
Q

What are signs of a moderate asthma attack?

A

PERF 50-75% of best/predicted,
Speech normal,
Resp rate < 25/min,
Pulse <110bpm,

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14
Q

What are the signs of a severe asthma attack?

A

PERF 33-50% of best/predicted,
Can’t complete full sentences,
RR >25/min,
HR > 110bpm

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15
Q

What are the signs of a life threatening asthma attack?

A

PERF < 33% of best/predicted.
Oxygen sats <92%,
Silent chest, cyanosis, poor resp effort, bradycardia, dysrhythmia, hypotension, exhaustion, confusion or coma.

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16
Q

What are the investigations for an asthma atack?

A
  • ABG if O2 sats < 92%
  • Chest X ray in life threatening asthma, pneumothorax, failure to respond to treatment
17
Q

What is the management of an acute asthma attack

A
  1. Oxygen. Maintain sats >94%
  2. Nebulised SABA
  3. Steroids (oral pred 40mg or IV hydrocortisone)
  4. Add Nebulised Ipratropium bromide - severe or life threatening or poor response to SABA.
  5. Consider IV magnesium sulphate with poor response to above. Senior decision.
  6. IV aminophylline - senior decision
18
Q

What are the treatment options for asthma in ITU?

A
  • Intubation and ventilation
  • ECMO (Ectracorporeal membrane oxygenation)
19
Q

What is the criteria for discharge following acute asthma attack?

A

Been stable on discharge meds (no oxygen or nebs) for 12-24hr,
Inhaler technique checked and recorded,
PER > 75% of best/predicted

20
Q

What is allergic bronchopulmonary aspergillosis?

A

Allergy from aspergillus spores. It presents with symptoms of bronchoconstriction and bronchiectasis. Will also have eosinophilia, positive RAST test and raised IgE

Phase 4 - Respiratory (14 decks)

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