Asthma Flashcards
What is the most accurate test in the diagnosis of asthma?
Spirometry: Shows FEV1 increase by 12% and 200 ml after salbutamol administration
What is the initial test of diagnosing asthma?
Peak expiratory flow rate: Increase by >20% the baseline first PEFR
State how asthma control is determined?
Given the patient’s age, sex and height, a predicted PEFR is determined using the chart, then the PEFR is measured on the visit 3 times and the highest value is taken and divided by the predicted PEFR.
If the ratio is below 0.8 then there is poor Asthma control
List 4 things that are part of the routine care of asthma patients checked in every visit.
- Asthma symptoms control
- Other symptoms such as dyspepsia, atopy and oral candida
- Adherence and inhaler technique
- Depression
List three circumstances a PEFR should be determined in an asthmatic.
- At diagnosis
- If change medications at last visit
- If symptoms worsen
Three indications of poor Asthma control based on symptoms.
- Daytime symptoms of >2 x a week
- Nocturnal cough, wheeze or tight chest >1 x a month
- Limitation of daily activities
What is the mainstay treatment of asthma and why?
Inhaled corticosteroids(Budesonide)
Why: They reduced exacerbation, hospitalisation and mortality ( Reduce inflammation)
BE CAREFUL: Salbutamol is for SYMPTOMATIC RELIEF NOT CONTROL
What should patients do to reduced frequency of oral candida when using asthma pumps?
Rinse and gargle the mouth after using inhaled corticosteroids
State the management of exercised induced asthma.
Use Salbutamol before exercise
What vaccines do people with Asthma and COPD need to get.
Annual influenza and once off pneumococcus vaccine which needs a booster every 5 years
Name the medication given after managing asthma exacerbation and state it’s duration of use.
Oral prednisone 40 mg daily for 7 days.
Only if it has not been used in the past 6 months >2 x
Are antibiotics given routinely in management of asthma exercabation?
Nope, only if there is fever and thick sputum( Give Amoxicillin/ Azithromycin)
They are given in COPD exacerbation
State the management of mild-moderate asthma exercabation in order.
- Give oxygen if Sats<94%
- Salbutamol nebulised
- High dose Budesonide(Inhaled corticosteroids)
When to review if:
1. Asthma is controlled
2. Asthma is not controlled
3. Acute exacerbation
- 3 months
- Monthly
- In a week
When should Budesonide be avoided in the management of asthma and what is it’s replacement?
When: If using lopinavir/ritonavir replace with beclomethasone.
NOTE: Fluticasone is also avoided in Same circumstances
Name three drugs that trigger asthma exacerbation
- Aspirin
- NSAIDs( Ibuprofen)
- Beta blocker(Atenolol)
Avoid at all cost.
List 6 triggers of asthma
- Viral URTI most common
- Drugs
- Animal
- Dust
- Pollen and grass
- Cigarette
- Occupational exposure.
State the treatment of intermittent asthma.
Salbutamol 2 puffs not more than 4 x per day
What determines whether the patient with an asthma exacerbation needs to be in the ICU and intubation?
Respiratory acidosis( low pH) is A BAD sign
List 4 side effects of inhaled corticosteroids.
- Osteoporosis
- Diabetes
- Eyes: Acute glaucoma and cataracts
- Oral candida(Most common)
Which one between male and female children are more likely to have asthma?
Male children are at a high risk.
However the female catch up in young adulthood
Is asthma more prevalent in males or females after the age of 40?
Females interestingly
List two exposures that are protective for asthma.
Frequent respiratory infections before diagnosis
Living in the farm
What is a bad sign in asthma exercabation?
Normal/low pH with tachypnoea: they indicate respiratory muscles fatigue
What does a normal/high PaCO2 in asthma exercabation indicate?
Early respiratory failure and respiratory muscle fatigue
State a diagnostic finding for obstructice airway disease.
FEV1/FVC<0.7
What objective thing is used to determine severity of asthma.
- Peak expiratory flow rate <80 % predicted
- FEV1
