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UKMLA > Asthma > Flashcards

Asthma Flashcards

1
Q

Asthma

A

chronic respiratory condition characterised by recurrent episodes of airflow obstructions, bronchial hyperresponsiveness, and underlying inflammation

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2
Q

Aetiology of asthma

A
  • genetics (FHx.)
  • environment (allergens, air pollution)
  • infections (viral URTIs)
  • sensitisation and atopy (eczema, rhinitis, food allergies)
  • sociodemographics (lower status, rural vs. urban)
  • lifestyle (diet and exercise)
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3
Q

Risk factors for asthma

A
  • personal or FHx. of atopy
  • antenatal exposure (smoking)
  • low birthweight
  • not breastfed
  • high allergen exposure
  • high air pollution
  • the ‘hygeine hypothesis’
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4
Q

Pathophysiology of asthma

A
  1. airflow obstruction (smooth muscle contraction by mast cells, eosinophils)
  2. mucous hypersecretion
  3. bronchial inflammation (from IgE dependent mast cell degranulation)
  4. ** airway hyperresponsiveness**
  5. airway remodelling
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5
Q

Symptoms of asthma

A

Cough:
- nocturnal
- dry
- non-productive

SOB:
- exercise
- cold air
- allergens

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6
Q

Clinical signs of asthma

A

Wheeze:
- expiratory
- polyphonic

Increased work of breathing:
- tachypnoea
- accessory muscle use
- head bobbing
- nasal flaring

In severe exacerbations:
- altered mental status
- silent chest
- cannot finish sentences
- significant tachycardia
- exhaustion

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7
Q

Investigating suspected asthma

A
  1. Spirometry with bronchodilator reversibility
  2. FeNO levels
  3. Peak expiratory flow diary
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8
Q

Spirometry results in asthma

A
  • > 5 years old
  • FEV1/FVC ratio < 70% (obstructive)
  • Bronchodilator reversibility +ve
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9
Q

Results of bronchodilator reversibility test in asthma

For 5-16 years & > 16 years

A

5-16:
- increase > 12% FVC

> 16:
- increase > 12% FVC
- increase > 200ml volume

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10
Q

FeNO results in asthma

For 5-16 years & 16+ years

A

5-16:
- FeNO > 35

16+:
- FeNO > 40

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11
Q

Peak flow findings in asthma

when measured for 2-4 weeks

A

more than 20% variability

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12
Q

Differentials for asthma in children

A
  • ciral induced wheeze
  • bronchiolitis
  • inhaled foreign body
  • cystic fibrosis
  • structural airway disease (e.g. bronchomalacia)
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13
Q

Stepwise treatment ladder in asthma

A
  1. SABA
  2. SABA + low-dose ICS
  3. SABA + low-dose ICS + LTRA (montelukast)
  4. SABA + low-dose ICS +/- LTRA + LABA
  5. SABA +/- LTRA + MART
  6. SABA +/- LTRA + medium-dose MART
  7. SABA +/- LTRA + high-dose ICS or theophylline
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14
Q

MART Regimen in Asthma

A
  • Maintenance & reliever therapy
  • Form of combined ICS and LABA
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15
Q

Complications of asthma

A
  • status asthmaticus
  • pneumonia
  • COPD
  • pneumothorax
  • airway remodelling
  • osteoporosis (long term steroids)
  • anxiety and depression (living with chronic disease)
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16
Q

Managing mild-moderate asthma exacerbation

A

First line:
- SABA 4-10 puffs/20mins
- oral corticosteroid

Consider:
- inhaled anticholinergic (ipratropium)
- controlled O2
- antibiotics

17
Q

Managing a severe exacerbation of asthma

A

First line:
- Hospital admission
- Nebulised SABA
- Oral/parenteral corticosteroid
- Controlled O2

Second line:
- Nebulised anticholingeric (ipratropium)
- Nebulised Magnesium sulfate
- IV salbutamol

Third line:
- antibiotics
- IM adrenaline
- Ventilation

18
Q

Managing a life-threatening exacerbation of asthma

A

First line:
- ICU admission
- Nebulised salbutamol
- Oral/parenteral corticosteroid
- Controlled O2

Second line:
- nebulised anticholinergic (ipratropium)
- nebulised magnesium sulfate
- IV salbutamol

Third line:
- antibiotics
- IM adrenaline
- ventilation

19
Q

Drugs used in asthma exacerbations

A
  • salbutamol (inhaled, nebulised, IV)
  • corticosteroids (oral, parenteral)
  • ipratropium (nebulised)
  • magnesium sulfate (nebulised)
20
Q

Discharge criteria for asthma exacerbation

A
  • Stable on SABA every 3-4 hours
  • Peak flow > 75% of best/predicted
  • O2 sats > 94% in room air
21
Q

Clinical features of mild/moderate asthma exacerbation

A
  • SpO2 > 92%
  • RR < 30
  • No or minimal accessory muscle use
  • Talking in full sentences
  • Wheeze (may only be audible with stethoscope)
22
Q

Clinical features of severe asthma exacerbation

A
  • SpO2 < 92%
  • PEFR 33-50% predicted
  • RR > 30
  • Can’t finish sentences
  • HR > 125
  • Use of accessory muscles
  • Audible wheeze
23
Q

Clinical features of life threatening asthma exacerbation

A
  • SpO2 < 92%
  • PEFR < 33% predicted
  • Silent chest
  • Poor respiratory effort
  • Altered consciousness
  • Agitated/confused
  • Exhaustion
  • Cyanosis

UKMLA (36 decks)

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