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Respiratory > Asthma > Flashcards

Asthma Flashcards

1
Q

What is the pathophysiology of asthma?

A

Airway hyperresponsiveness is triggered by environmental factors
- Activation of Th2 cells results in eosinophil Activation, IgE production and mast cell degranulation
- This causes a reversible airflow obstruction

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2
Q

What are the risk factors for asthma?

A

History of atopy
Family history
Exposure to allergens
Occupational exposure

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3
Q

What are the typical triggers for asthma?

A

Infection
Nighttime or early morning
Exercise
Animals
Cold, damp or dusty air
Strong emotions

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4
Q

What are the clinical features of asthma?

A

Episodic shortness of breath - diurnal variation
Dry cough
Wheeze
Chest tightness

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5
Q

What are the primary investigations for asthma?

A

Fractional exhaled nitric oxide (FeNO)
Spirometry and bronchodilator reversibility
Peak flow diary

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6
Q

What FeNO level is indicative of asthma?

A

> 40ppb

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7
Q

What peak flow variability is indicative of asthma?

A

> 20%

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8
Q

What spirometry results are indicative of asthma?

A

An FEV1:FVC ratio of less than 70%

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9
Q

What are the NICE guidelines for management of asthma?

A

First line - SABA
Second line - ICS (low dose)
Third line - Leukotriene receptor antagonist
Fourth line - LABA
Fifth line - consider changing to a maintenance and reliever therapy regime
Sixth line - increase ICS to moderate dose
Seventh line - consider high dose ICS

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10
Q

What are the presenting features of an acute asthma exacerbation?

A

Progressive shortness of breath
Use of accessory muscles
Tachypnoea
Symmetrical expiratory wheeze

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11
Q

What are the features of a moderate asthma exacerbation?

A

Peak flow 50-75% of best

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12
Q

What are the features of a severe asthma exacerbation?

A

Peak flow 33-50% of best/predicted
RR > 25
HR > 110
Unable to complete sentences

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13
Q

What are the features of a life-threatening asthma exacerbation?

A

PEFR < 33%
SpO2 < 92%
PO2 < 8
PCO2 normal
Altered consciousness
Exhaustion
Arrhythmia
Hypotension
Silent chest

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14
Q

What are the features of a near-fatal asthma attack?

A

High pCO2

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15
Q

What investigations are helpful in an acute asthma exacerbation?

A

PEFR
ABG
Inflammatory markers - look for infective trigger
CXR - hyperexpansion/infection

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16
Q

What is the initial management of an acute asthma exacerbation?

A

Admission - all patients with life-threatening asthma
Oxygen
Bronchodilation - SABA
40-50mg oral prednisolone
Ipratropium bromide nebulisers if not responding or if life-threatening asthma

17
Q

What is the further management of an acute asthma exacerbation?

A

IV magnesium sulfate
IV aminophylline
ICU admission

18
Q

What is the criteria for discharge in acute asthma exacerbation?

A

Have been stable on their discharge medication for 12-24 hours
Inhaler technique checked and recorded
PEF > 75% of best or predicted

Respiratory (12 decks)

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