Asthma Flashcards

1
Q

What is asthma?

A
  • Chronic Inflammatory Airway Disease • Variable & Reversible Airway Obstruction • Airway Hyper responsiveness • Bronchial Inflammation
  • Affects Children & Adults
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2
Q

What is the epidemiology of asthma?

A

• Asthma prevalence is thought to have plateaued since the late 1990s, although the UK still has some of the highest rates in Europe and on average 3 people a day die from asthma.
It affects M=F.
It is the most common long term condition in children.

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3
Q

What’s the aetiology of asthma?

A

• Environment vs Genetic
– Influence severity & responsiveness
• Environment
– Allergens / Air Pollution
– Smoking during Pregnancy
– Low air quality
– Formaldehyde (attack)
– PVC
– Indoor Allergens (dust mites / cockroaches / animal dander / mould)
– Virus
• HygieneHypothesis – Reduced expose to non pathogenic bacteria / virus
– Increased Cleanliness
– Decreased Family Size
– Exposure to bact. Endotoxin in child hood protective
– Exposure to bact. Endotoxin in adulthood may provoke bronchoconstriction
– Antiobiotic Usage – C-Section
• Genetic
• Medical Conditions – Atopic Eczema, Allergic Rhinitis, Asthma – Atopy
• Obesity • Beta Blocker - propanolol
– Cardioselective are safer • NSAIDS / ACEi

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4
Q

What is the pathophysiology of asthma?

A

– Exposure to allergen
– Cross linking of IgE
– Mast Cell Degranulation
– Histamine release
– Mucous Hypersecretion
– Vasodilation
– Oedema
– Bronchoconstriction leading to Airway Obstruction
– Late phase: mixed inflammatory cell infiltrate & acculumation leading to further bronchial hyper responsiveness
– High power: Luminal Mucous Plugs, Epithelial Shedding, Mixed Cell infiltrate, Odema, submucosal gland hyperplasia, smooth muscle hypertrophy

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5
Q

What would a patient’s history be like with asthma?

A
  • Variable
  • Episodes of Wheeze
  • Chest Tightness
  • Breathlessness
  • Cough – worse in morning / night • Related to exercise / cold weather
  • Associated with: GORD / OSA / Rhinosinusitis
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6
Q

On examination what would you find?

A
  • Tachypnoea • Use of Accessory Muscles • Prolonged Expiratory phase • Polyphonic Wheeze • Hyperinflated chest
  • Severe Attack: PEFR 110/min RR>25/min, inability to complete sentences
  • Life Threatening Attack: PEFR<33%, silent chest, cyanosis, bradycardia, hypotension, confusion, coma.
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7
Q

Is a chest x-ray necessary?

A

No, unless worried about an alrernative diagnosis.

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8
Q

How do you measure FEV? (forced expiratory volume)

A

With the blowey tube thing.

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9
Q

What’s the blue inhaler for?

A
  • Generally a Beta Agonist

* For Treatment of an attack

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10
Q

What’s the brown inhaler for?

A
  • It’s a Preventer

* A Steroid (to reduce inflammation)

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11
Q

What are some non pharmacological methods to prevent asthma?

A
  • Numerous – many with no evidence
  • Breast Feeding
  • Avoidance of Tobacco Smoke
  • Weight Reduction
  • House Dust Mites
  • Allergen Specific Immunotherapy
  • Buteyko Technique
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12
Q

What’s the pharmacological therapy for asthma?

A
  • Aim for control: no daytime symptoms, no night time awakening, no need for rescue medication, no exacerbations, no exercise limitation, normal lung function (>80% predicted)
  • Regular review, Step down treatment as required.
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13
Q

What’s the treatment for each severity of asthma?

A
  1. Mild intermittent asthma = Inhaled Beta Agonist PRN
  2. Regular Preventer Therapy = Add inhaled steroid
  3. Initial add – on therapy = Add LABA / Increase Steroid / Trial Alternative Agent
  4. Persistent Poor Control = Increase Steroid / Leukotriene RA, Theophylline, Oral Beta Agonist
  5. Frequent use of Oral Steroids = Oral steroid
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14
Q

What is the treatment process in an asthma attack?

A
  • Oxygen(>94-98%) • Nebulised B2 Agonist • OralSteroid • Nebulised Ipratropium Bromide
  • MagnesiumSulphate • Nebulised Adrenaline • Ketamine
  • No Antiobiotics
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