Asthma Flashcards

1
Q

Normal spirometry does not exclude asthma

Common reasons for lack of reversibility

A

Baseline FEV1 is normal
Recent use of a bronchodilator
Airway inflammation & oedema (poorly controlled asthma) – reversibility may return after treatment

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2
Q

Asthma is a disease of the airways characterised by:

A
  1. Variable airflow obstruction
  2. Bronchial hyper-responsiveness
  3. Airway inflammation
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3
Q

use of peak flow monitoring in asthma diagnosis

A

A period of peak flow monitoring (2 weeks at least) can be very useful if the diagnosis is uncertain or if occupational asthma is suspected (PEF low in certain places/ scenarios)

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4
Q

When is laboratory confirmation of bronchial hyper-responsiveness used?

A

Only occasionally needed where clinical features are atypical or where the diagnosis has important implications (defence force employment)

Unnecessary if clinical features and treatment response are typical of asthma
Unnecessary if variable airflow obstruction has already been documented
Can be hazardous in setting of poorly controlled asthma or severe airflow obstruction

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5
Q

Use of Exhaled nitric oxide testing

A

marker of allergic inflammation, steroid responsiveness

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6
Q

Use of blood eosinophil count

A

if >0.3 x 10 9per litre, airway eosinophilia is likely

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7
Q

Samter’s triad

A

Asthma, aspirin intolerance, nasal polyps

“Aspirin-exacerbated respiratory disease”

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8
Q

ABPA clinically (and Ix)

A

Chronic asthma, recurrent pulmonary infiltrates, bronchiectasis
Very high total IgE (>1000 IU/mL)
Evidence of Aspergillus sensitivity

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9
Q

EGPA clinically

A

Necrotising Vasculitis, granulomas, tissue eosinophilia

Asthma + blood eosinophilia essential

Cardiac disease accounts for 50% of deaths

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10
Q

STEP 1 in asthma management 2019 GINA guidelines

A

PRN Low dose ICS-formeterol

OR

SABA + ICS

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11
Q

STEP 2 in asthma management 2019 GINA guidelines

A

Regular LOW dose ICS-formeterol (plus PRN)
OR
Regular low dose ICS

Consider montelukast

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12
Q

STEP 3 in asthma management 2019 GINA guidelines

A

Daily LOW dose ICS-formeterol (plus PRN)

OR consider
Medium Dose ICS
Consider montelukast (w low dose ICS)

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13
Q

STEP 4 in asthma management 2019 GINA guidelines

A

Daily MEDIUM dose ICS-formeterol (plus PRN)

consider
- add on tiotropium
- montelukast
- high dose ICS

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14
Q

STEP 5 in asthma management 2019 GINA guidelines

A

Daily HIGH dose ICS-formeterol (plus PRN)
AND
Phenotypic assessment + immunological

consider
- OCSs

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15
Q

place for long term oral steroids in asthma

A

Adrenal insufficiency

Asthma variants
* Allergic bronchopulmonary aspergillosis (induction therapy)
* Eosinophilic granulomatosis with polyangiitis (EGPA)

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16
Q

Low dose oral steroids adverse effects in asthma patients

A
17
Q

Clues for add on therapies for severe asthma

A

Tiotropium - Airflow obstruction, exacerbations
Macrolides - Exacerbations, cough & sputum
Montelukast - Aspirin sensitive
Monoclonal Abs - Exacerbations, type 2 biomarker

18
Q

Use of specific biologics for asthma

A

These monoclonal Abs are used in addition to ICS + LABA.

In appropriately selected patients, mABs induce ~50% reduction in exacerbations

Oral steroid sparing

Modest improvements in lung function

19
Q
A