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Respiratory Block > Asthma > Flashcards

Asthma Flashcards

1
Q

What is asthma?

A

A disease characterised by an increased responsiveness of the trachea and bronchi to various stimuli and manifested by a widespread narrowing of the airways that changes in severity either spontaneously or as a result of therapy.

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2
Q

What word is asthma derived from?

A

Aazein - To pant heavily or gasp for breath

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3
Q

Why is asthma important?

A

Common

Dangerous

Expensive

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4
Q

What is the prevalence of asthma?

A

5.4 million on treatment incidence is higher in children but increasing in adults.

75% of hospital admissions for asthma are avoidable.

~1200 people die a year (women > men) 90% of deaths are preventable.

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5
Q

What is the cost to Nhs?

A

£1 billion a year

60,000 admissions/year

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6
Q

Asthma: the scale of the problem

A

5.4 million people living with asthma in the uk

Every 10 seconds someone is having a potentially life-threatening asthma attack in the uk

Every day, the lives of three families are devastated by the death of a loved one to an asthma attack - 2/3 of these deaths are preventable.

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7
Q

Pathophysiology of asthma

A

Airway inflammation mediated by the immune system - Increased airway reactivity - Airway narrowing - Spontaneously stimuli

Airway inflammation mediated by the immune system - Widespread narrowing of airways.

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8
Q

What is atopy?

A

-Atopy is the body’s predisposition to develop an antibody called immunoglobulin E (lgE) in response to exposure to environmental allergens and is an inheritable trait.

-Associated with allergic rhinitis, asthma, hay fever and eczema.

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9
Q

What does a structured clinical assessment for asthma look like?

A

Recurrent episodes of symptoms

Symptom variability

Absence of symptoms of alternative diagnosis.

Recorded observation of wheeze

Personal history of atopy

Historical record of variable PEF or FEV.

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10
Q

What are the symptoms of asthma?

A

Wheeze

Shortness of breath (dyspnoea), severity.

Chest tightness

Cough, paroxysmal, usually dry

Sputum (occasional)

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11
Q

What is normal peak expiratory flow rate?

A

80-100% of predicted

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12
Q

What type of hypersensitivity is asthma?

A

Type 1

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13
Q

What is the main cause of chronic bronchitis and emphysema?

A

Smoking

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14
Q

How is chronic bronchitis defined?

A

A chronic productive cough for 3 months out of a year, for at least 2 consecutive years.

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15
Q

What are the morphological changes in large airways in chronic bronchitis?

A

Mucus gland hyperplasia

Goblet cell hyperplasia

Inflammation and fibrosis

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16
Q

What are the morphological changes in small airways in chronic bronchitis?

A

Goblet cells appear

Inflammation and fibrosis.

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17
Q

How is emphysema pathologically defined?

A

Increase in the size of airspace distal to the terminal bronchiole arising from either dilation or from destruction of their walls and without obvious fibrosis.

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18
Q

What is the acinus?

A

Everything that is distal to the terminal bronchiole.

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19
Q

What are the 2 main types of emphysema?

A

Centri-acinar emphysema

Pan-acinar emphysema

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20
Q

Where does centriacinar emphysema usually effect?

A

Upper regions of lung lobes

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21
Q

Where does panacinar emphysema usually effect?

A

Lower regions of lung lobes

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22
Q

What would be seen on a chest x-ray of someone with emphysema?

A

Hyperinflated lungs, indicated by more ribs highlighted than usual.

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23
Q

What can alpha-1 antitrypsin deficiency cause?

A

Emphysema

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24
Q

What is the role of alpha 1 antitrypsin?

A

Inhibits elastase which prevents breakdown of lung tissue.

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25
Q

How does smoking cause emphysema?

A

Smoking decreases alpha-1-antitrypsin activity

It increases neutrophil and macrophage activity therefore increasing elastase production even further.

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26
Q

How does emphysema impact smaller airways?

A

Loss of alveolar attachments

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27
Q

What is cor pulmonale?

A

Abnormal enlargement of the right side of the heart as a result of disease of the lungs or the pulmonary blood vessels.

28
Q

What causes cor pulmonale?

A

Pulmonary hypertension caused by chronic pulmonary vasoconstriction

29
Q

What is the main symptom of asthma?

A

Wheeze

30
Q

What % of causation of asthma is gene related?

A

30-80%

31
Q

What 2 tests can be useful for determining a diagnosis of asthma in children?

A

Spirometry and nitrous oxide test

32
Q

What are the features of a cough in a child with asthma?

A

Dry, nocturnal, exertional

33
Q

In a child, what should you prescribe as a trial for suspected asthma?

A

Inhaled corticosteroid for a 2 month trial, then stop to see if symptoms return.

34
Q

What are the ideal factors to diagnose asthma?

A

Wheeze

SOB

Parental asthma

Responsive to treatment

35
Q

What are the goals of asthma treatment?

A

Minimal symptoms during day and night

Minimal need for reliever medication

No exacerbations

No limitation of physical activity

36
Q

What mnemonic is used to measure control of asthma in children?

A

SANE

Short acting beta agonist/week

Absence school/nursery

Nocturnal symptoms/week

Exertional symptoms/week

37
Q

What is the contrast of asthma treatment in children under 12 compared to adults?

A

Max dose ICS 800mg

No oral beta 2 tablet

No LAMAs

LTRA first line preventer in ,5s

Only 2 biologicals

38
Q

How often would you need to use a beta 2 agonist to be considered uncontrolled?

A

More than 2 days a week

39
Q

What is the adverse effects of inhaled corticosteroid steroids?

A

Height suppression (0.5-1cm)

40
Q

What is the main leukotriene receptor antagonist?

A

Montelukast

41
Q

What are the 2 types of delivery methods used in medication for asthma?

A

MDI/spacer

Dry powder device

42
Q

Name 3 ways that lung composition can be increased when using metered dose inhaler (MDI)

A

Use spacer

Shake inhaler between puffs

Wash spacer monthly

43
Q

What are the non-pharmacological treatments for asthma?

A

Reduce tobacco smoke exposure

Remove environmental triggers

44
Q

What are the methods of drug administration used for treating acute and chronic asthma in children?

A

Chronic asthma - Inhaled steroids

Acute asthma - Oral steroids

45
Q

What are the factors that determine level of treatment required in acute asthma exacerbation?

A

Respiratory rate

Heart rate

Oxygen sats

Work of breathing

Ability to complete sentences

46
Q

When prescribing a LABA inhaler for a child, what 2 things are necessary?

A

Do not use without ics

Use as fixed dose inhaler

47
Q

What is the prevalence of asthma in children?

A

10-15%

48
Q

Give 3 proven risk factors for developing asthma

A

Hereditary

Maternal smoking

Occupation

49
Q

Name triggers of asthma

A

Exercise

Cold air

Cigarette smoke

URTIs

Drugs (aspirin, NSAIDS)

Pets

Pollen

50
Q

Name some differential diagnosis of asthma

A

COPD

Bronchiectasis

Cystic fibrosis

Lung tumour

Cardiac related disease

51
Q

Name 4 tests that are used to try and diagnose asthma

A

Spirometry

Full pulmonary function test

Reversibility of bronchodilator

Variability of airflow obstruction

52
Q

What are factors to consider when assessing acute asthma exacerbations?

A

Ability to speak

Heart rate

Respiratory rate

Peak expiratory flow rate

Oxygen saturation

53
Q

What are the clinical features of someone having a moderate asthma exacerbation?

A

Able to speak in sentences

HR < 110

RR < 25

PEF - 50%-75% of predicted/best

SpO2 > 92%

PaO2 > 8pKa

54
Q

What are the clinical features of someone having a severe asthma exacerbation?

A

Unable to finish sentences in one breath

Heart rate > 110

Respiratory rate > 25

PEF - 33-50% of predicted/best

SpO2 > 92%

PaO2 > 8pKa

55
Q

What are the clinical features of someone having a life threatening asthma exacerbation?

A

Grunting

Exhaustion

Impaired consciousness

Bradycardia

Arrhythmia

Hypotension

PEF < 33% of predicted/best cyanosis

Silent chest

SpO2 < 92% (needs blood gas)

PaO2 < 8pKa

PaCO2 normal (4.6-6.0pKa)

Poor respiratory effect

56
Q

What are the clinical features of someone having a near fatal asthma exacerbation?

A

Raised PaCO2

Requiring mechanical ventilation with raised inflation pressures

57
Q

Name 4 non-pharmacological managements for asthma

A

Exercise

Smoking cessation

Weight management

Flu/pneumococcal vaccine

58
Q

What are the 2 main SABA inhalers?

A

Salbutamol (MDI and DPI)

Terbutaline (DPI)

59
Q

Name 3 oral therapies used to treat asthma

A

Leukotriene receptor antagonist

Theophylline

Prednisolone

60
Q

Name 3 specialist therapies used to treat asthma

A

Omalizumab (anti-lgE)

Mepolizumab (anti-interleukin-5)

Bronchial thermoplasty

61
Q

What treatment can be used for a patient having a mild/moderate asthma attack?

A

Increase inhaler use

Oral steroid

Treat trigger

Early follow up

Back up plan

62
Q

What treatment can be used for a patient having a moderate/severe asthma attack?

A

Nebuliser - Salbutamol/Ipratropium

Oral/Iv steroid

Magnesium

Aminophylline

Triggers - Infection/allergen

Complications - CXR

Review

Level 2/3 care

63
Q

What are some of the contrast between COPD and asthma?

A

Age of onset

Smoking history

Response to treatment

Treatment goals

Trajectory

64
Q

What are some of the similarities between COPD and asthma?

A

Similar therapies

Same non-pharmacological interventions

65
Q

What is the main difference between asthma and COPD?

A

Reversibility

66
Q

Inhalers

A

Small dose of drugs

Delivery directly to the target organ (airways and lung)

Onset of effect is faster

Minimal systemic exposure

Systemic adverse effects are less severe and less frequent

67
Q

What can complete control of asthma be defined as?

A

No daytime symptoms

No night time wakening

No need for rescue medication

No asthma attacks

No limitations on activity including exercise and normal lung function ( in practical terms FEV1 and/or PEF > 80%)

Minimal side effects from medication.

Respiratory Block (14 decks)

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