Asthma Flashcards
What is asthma
chronic resp condition with airway inflammation and hyper-responsiveness
variable over time
eosinophilia
How does someone with asthma present
cough - worse at night
breathlessness
wheezing
recent upper resp tract infection
chest tightness
What are some risk factors for asthma
other atopic features
eczema
hay fever
allergic rhinitis
family history
smoking
What are the first line investigations for asthma
Spirometry with bronchodilator reversibility
FeNO for eosinophilic inflammation
What will spirometry with. bronchodilator reversibility show
Reduced FEV1- improvement by 12% or more
Normal FVC
FEV1/FVC < 70%
Obstructive disease
What will FeNO show
40ppb or more is positive in adults
35ppb or more is positive in children
Not for < 5years old
What other investigations are needed
peak expiratory flow rate
CXR
FBC- eosinophils >0.3
How do you assess the severity of acute asthma exacerbation
mild/ moderate
severe
life-threatening
What makes an acute asthma exacerbation mild/ moderate
SpO2 >92%
RR
<30-over 5s
<40 - under 5s
no/minimal accessory muscle use
feeding well/talking in full sentences
wheeze
What makes an acute asthma exarcebation severe
SpO2 <92%
PEFR - 33-50% of predicted
RR
>30- over 5s
>40- under 5s
too breathless to feed/talk
HR
>125 - over 5s
>140- under 5s
use of accessory muscles
audible wheeze
What makes an acute asthma exacerbation life threatening
SpO2 <92%
PEFR <33% predicted
silent chest
poor resp effort
altered consciousness
agitation/confusion
exhaustion
cyanosis
How do you manage asthma
SABA is first line
– add ICS if regular exarcebations
add LTRA
then increase ICS if not responding well
Add LABA
How do you manage an acute asthma attack
Hospital admission for life threatening and unresponsive severe
15L oxygen via non-rebreathe mask, target 94-98%
SABA- salbutamol, terbutaline
Corticosteroid- 40-50 mg oral prednisolone for 5 days or until patient recovers
SAMA if not responding/severe or life threatening - IPRATROPIUM BROMIDE
What is the criteria for discharging after an acute asthma attack
Stable on discharge medication for 12-24hrs
Inhaler technique checked and recorded
PEF >75% of best or predicted
What is allergic bronchopulmonary aspergillosis
Hypersensitivity reaction to bronchial colonisation by Aspergillus fumigatus mould
affects patients with asthma
