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Pulmonology > Asthma > Flashcards

Asthma Flashcards

1
Q

Asthma

A

A chronic inflammatory condition of airways

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2
Q

Main two parameters in asthma

A
  • Reversible airway obstruction
  • Bronchial hyper-reactivity
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3
Q

Pathogenesis of asthma

A
  • Trigger – not known in many (intrinsic)
  • Release of mediators
  • Inflammation leading to airway obstruction
  • Bronchial hyper-reactivity
  • Increased response to environmental triggers
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4
Q

pathology of asthma

A
  • Smooth muscle contraction
  • Mucosal oedema
  • Mucous plus
  • Denuded epithelium
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5
Q

common triggers of asthma

A
  • Infection
  • Tobacco smoke & cooking fumes
  • Occupational – wood dust, grain dust, flour
  • House hold – dust, pets, mould, cockroach
  • Food – allergies, preservatives, colouring
  • Drugs – aspirin, NSAIDs, beta blockers
  • Exercise
  • Emotion
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6
Q

Asthma clinical features

A
  • Recurrent episodes of
    o Wheezing
    o Breathlessness
    o Chest tightness
    o Coughing
  • Particularly at night or in the early morning
  • Variable airflow obstruction, reversible either
    spontaneously or with treatment
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7
Q

what features confirm asthma

A
  • Airflow limitation
  • Reversibility
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8
Q

what devices can be used to confirm the Dx of asthma

A

Peak flow meter
Spirometry

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9
Q

how to confirm obstructive nature of the disease

A

FEV1/FVC <70%

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10
Q

To assess the reversibility of bronchoconstriction in asthma

A

repeat FEV1 after salbutamol nebulizer

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11
Q

FEV1 levels after bronchodilator in asthma

A

> 12%

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12
Q

PEFR value in asthma after bronchodilator

A

increased by 60 L/min or 20% or previous
value

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13
Q

PEFR diurnal variation of asthma

A

> 10%

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14
Q

other Ix done on asthma

A
  • WBC/DC
  • CXR-AP
  • PEFR
    o Monitoring the disease
    o Assessing the response to drugs
    o Occupational asthma – to confirm the
    relationship with work
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15
Q

Main principle of Rx of asthma

A

to avoid allergens

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16
Q

Main pharmacological principles in Mx of asthma

A
  • Influence bronchial smooth muscles
  • Reduce inflammations
  • Inhibit release of mediators
  • Inhibit production of mediators
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17
Q

which drug classes influence bronchial smooth muscles

A

Beta receptor agonists
anticholinergics
Xanthines

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18
Q

Sympathetic beta receptor agonists

A

 Short acting – salbutamol, terbutaline
 Long acting – salmeterol, formeterol

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19
Q

Parasympathetic – anticholinergics

A

 Short acting – ipratropium
 Long acting - tiotropium

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20
Q

Xanthines

A

theophyllines

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21
Q

what can be done to reduce inflammation in asthma

A

o Glucocorticoids (inhaled)
 Beclamethasone
 Budesonide
 Fluticasone
o Glucocorticoids (oral or IV)

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22
Q

inhibiting release of mediators in asthma

A

Mast cell stabilizers – sodium cromoglycate

23
Q

Inhibiting production of mediators in asthma

A

Leukotriene modifiers – montelukast

24
Q

the two tracks of asthma Mx

A

Controller + preferred reliever
Controller+ alternative reliever

25
Q

the preferred reliever

A

low dose ICS- formeterol combo

26
Q

alternative reliever

A

SABA

27
Q

Step 1 and 2 of track 1 in asthma Mx

A

preferred reliever as needed

28
Q

Step 3 of track 1 in asthma Mx

A

low dose ICS- formoterol for both maintenance and reliever therapy (MART)

29
Q

Step 4 of track 1 in asthma Mx

A

medium dose ICS- formoterol as maintenance
low dose ICS- formoterol as reliever

30
Q

Step 1 of track 2 in asthma Mx

A

SABA as needed for reliever
low dose ICS whenever SABA is taken

31
Q

Step 2 of track 2 in asthma Mx

A

Maintenance low dose ICS controller and SABA as needed as the reliever

32
Q

Step 3 of track 2 in asthma Mx

A

low dose maintenance ICS- LABA controller
SABA as needed as the reliever

33
Q

Step 4 of track 2 in asthma Mx

A

medium/ high dose maintenance ICS- LABA as the controller
SABA as reliever

34
Q

Step 5 asthma Mx both tracks

A

refer to phenotypic investigations +/- add on therapy

35
Q

Acute exacerbations of bronchial asthma

A

admit the patient and give a bed
Assess the severity of the episode
 PaCO2 normal in life threatening asthma but raised PaCO2 in near fatal asthma
 Connect to a monitor, measure the oxygen saturation
 Administer high flow oxygen
 Give oxygen driven nebulization with salbutamol 5mg every 15-30 minutes
 Add ipratropium bromide 500 micrograms nebulized every 6 hours
 Monitor the response
 Give hydrocortisone 200mg IV

36
Q

difference between acute severe asthma and life threatening asthma

A

Acute severe asthma Inabiity to complete a single sentence in one breath
RR>25/min
HR >110/min
PEFR between 33-50% of best or predicted

Life threatening asthma
Exhausted, confused or comatose
Poor respiratory effort
Bradycardia and hypotension
Cyanosis, SpO2<92%, PaCO2< 8kPa, silent chest
PEFR <33% of expected or predicted

37
Q

PaCO2 levels in life-threatening asthma

A

PaCO2 normal

38
Q

Near fatal asthma PaCO2 levels

A

Raised

39
Q

Dose of ipratropium bromide in Mx of acute exacerbation of bronchial asthma

A

500mcg nebulized every 6 hours

40
Q

If the patient is not responding to initial treatment consider adding

A

IV Magnesium sulphate
IV salbutamol
Exclude pneumothorax
ABG and ICU care

41
Q

SABA

A

Salbutamol

42
Q

Side effects of SABA

A

tremors

43
Q

Which patients gets categorized into steps 1-2 of track 1 of asthma Mx

A

Sx less than 4-5 days in a week

44
Q

Which patients gets categorized into steps 3 of track 1 of asthma Mx

A

Sx most days, or walking w asthma once a week or more

45
Q

Which patients gets categorized into steps 4 of track 1 of asthma Mx

A

Daily Sx, or walking with asthma once a week or more, and low lung function

46
Q

Which patients gets categorized into step 1of track 2 of asthma Mx

A

Sx less than twice a month

47
Q

Which patients gets categorized into step 2 of track 2 of asthma Mx

A

Sx twice a month, or more, but less than 4-5 days a week

48
Q

Which patients gets categorized into step 3 of track 2 of asthma Mx

A

Sx most days, or walking with asthma once a week or more

49
Q

Which patients gets categorized into step 4 of track 2 of asthma Mx

A

Daily Sx or walking with asthma once a week or more and low lung function

50
Q

ARDS of inhaled corticosteroids

A

oral candidiasis
stunted growth in children

51
Q

ICS examples

A

Beclometasone
dipropionate
Fluticasone
Propionate

52
Q

LABA examples

A

Salmeterol

53
Q

Leukotriene receptor antagonists example

A

Monteleukast

54
Q
A

Pulmonology (13 decks)

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