Asthma Flashcards
What is atopy?
Genetic tendency to develop IgE antibodies in response to common environmental allergens which enter through intact mucosal surfaces
What does the atopic triad consist of?
Asthma, eczema and rhinitis
Asthma is a chronic disease characterised by r____ a____ o___, airway hyperresponsiveness, inflamed bronchioles and mucous hypersecretion
reversible airway obstruction
Allergic asthma is ___ mediated and a type _ hypersensitivity
IgE
type 1
Allergic asthma (70%) often presents early with common triggers being…
Pollen
Smoke
Dust
Mould
Antigens
Is non-allergic asthma IgE mediated?
No
Associated with smoking
Is allergic or non-allergic asthma easier to treat?
Allergic asthma
What can trigger asthma flare ups?
Infection
Allergen
Cold weather
Exercise
Drugs (beta-blockers, aspirin)
What is Samter’s triad?
Nasal polyps (painless growths in nose or sinuses)
Asthma
Aspirin sensitivity (problems when taking NSAIDs like wheezing, coughing, sneezing)
The pathophysiology of asthma involves the overexpression of ___ cells
TH2
What is the role of the TH2 cells in asthma?
Release cytokines (IL 3, 4, 5, 13)
Produce IgE
Recruit eosinophil
What does IgE trigger in asthma?
Mast cell degranulation releasing histamines, leukotrienes and tryptase
Triggers bronchial constriction and mucous hypersecretion
Overtime, asthma causes chronic remodelling leading to bronchial s____
scarring
What are symptoms of asthma?
Wheeze
Dry cough
Chest tightness
SOB
What is the PEF (peak flow) in moderate episode of asthma?
50-75% PEF
What is the PEF (peak flow) in severe episode of asthma?
PEF 33-50%
Can’t reach end of sentences
What is the PEF in life threatening asthma?
Under 33% with decreased consciousness and silent chest
What test measures fractional exhaled nitric oxide which indicates level of lung inflammation when diagnosing asthma
FeNO devices
What ratio of FEV1:FVC shows obstruction?
Less than 0.7
If there is less than 12% improvement of FEV1 when using a bronchodilator, what condition is it?
COPD
How much will the FEV1 improve with a bronchodilator in asthma?
At least 12% improvement
What is the first step in treatment for asthmas in over 16 y/os?
SAB2A as required
What is the second stage in treatment for asthma in over 16 y/os?
ICS (inhaled corticosteroids)
If both a SAB2A and ICS isn’t helping improve the asthma, what should be done?
Assess the inhaler technique and compliance
What is the 3rd stage in treatment of asthma?
Add a LTRA (leukotriene receptor antagonist)
eg. Montelukast
alongside a SAB2A and ICS
What is the 4th stage in treatment of asthma?
Give a LAB2A with or instead of the LTRA
(Alongside SAB2A and ICS)
What is the 5th stage in treatment of asthma?
Increase dose of ICS
so now taking:
SAB2A, ICS (higher dose), LAB2A +/- LTRA
Give an example of a SABA for asthma
Salbutamol
Give an example of a LABA for asthma
Salmeterol
Give an example of a SAMA (short acting muscarinic antagonist)
Ipratropium bromide
Give an example of a LAMA
tiotropium bromide
What mnemonic helps to recall treatment for asthma excaerbations
OSHITME
How do you treat an exacerbation of asthma?
Oxygen
SABA (nebulised)
Hydrocortisone (ICS)
Ipratropium bromide
Theophylline (IV)
MgSO4 (IV, bronchodilator)
Escalate (intubation and ventilation)
Should CPAP or BPIP be used for asthma?
BIPAP (CPAP may cause asthma attacks)
