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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
the preferred reliever
low dose ICS- formeterol combo
26
alternative reliever
SABA
27
Step 1 and 2 of track 1 in asthma Mx
preferred reliever as needed
28
Step 3 of track 1 in asthma Mx
low dose ICS- formoterol for both maintenance and reliever therapy (MART)
29
Step 4 of track 1 in asthma Mx
medium dose ICS- formoterol as maintenance low dose ICS- formoterol as reliever
30
Step 1 of track 2 in asthma Mx
SABA as needed for reliever low dose ICS whenever SABA is taken
31
Step 2 of track 2 in asthma Mx
Maintenance low dose ICS controller and SABA as needed as the reliever
32
Step 3 of track 2 in asthma Mx
low dose maintenance ICS- LABA controller SABA as needed as the reliever
33
Step 4 of track 2 in asthma Mx
medium/ high dose maintenance ICS- LABA as the controller SABA as reliever
34
Step 5 asthma Mx both tracks
refer to phenotypic investigations +/- add on therapy
35
Acute exacerbations of bronchial asthma
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
difference between acute severe asthma and life threatening asthma
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
PaCO2 levels in life-threatening asthma
PaCO2 normal
38
Near fatal asthma PaCO2 levels
Raised
39
Dose of ipratropium bromide in Mx of acute exacerbation of bronchial asthma
500mcg nebulized every 6 hours
40
If the patient is not responding to initial treatment consider adding
IV Magnesium sulphate IV salbutamol Exclude pneumothorax ABG and ICU care
41
SABA
Salbutamol
42
Side effects of SABA
tremors
43
Which patients gets categorized into steps 1-2 of track 1 of asthma Mx
Sx less than 4-5 days in a week
44
Which patients gets categorized into steps 3 of track 1 of asthma Mx
Sx most days, or walking w asthma once a week or more
45
Which patients gets categorized into steps 4 of track 1 of asthma Mx
Daily Sx, or walking with asthma once a week or more, and low lung function
46
Which patients gets categorized into step 1of track 2 of asthma Mx
Sx less than twice a month
47
Which patients gets categorized into step 2 of track 2 of asthma Mx
Sx twice a month, or more, but less than 4-5 days a week
48
Which patients gets categorized into step 3 of track 2 of asthma Mx
Sx most days, or walking with asthma once a week or more
49
Which patients gets categorized into step 4 of track 2 of asthma Mx
Daily Sx or walking with asthma once a week or more and low lung function
50
ARDS of inhaled corticosteroids
oral candidiasis stunted growth in children
51
ICS examples
Beclometasone dipropionate Fluticasone Propionate
52
LABA examples
Salmeterol
53
Leukotriene receptor antagonists example
Monteleukast
54

Pulmonology (13 decks)

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