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General Medicine > Asthma > Flashcards

Asthma Flashcards

0
Q

What is required for a diagnosis of asthma?

A

Demonstration of REVERSIBLE airflow obstruction by spirometry or peak flow rate

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1
Q

The pathogenesis of asthma is explained by the 3 S’s which are?

A

Spasm of smooth muscle
Swelling/ oedema of bronchial mucosa
Secretions from hypertrophic mucous glands - thick+tenacious mucous

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2
Q

Immune cells involved in asthma?

X3

A

Eosinophils, mast cells and lymphocytes

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3
Q

Host risk factors for Asthma

A

Atopic tendencies

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4
Q

Environmental risk factors for asthma

X2

A

Allergens (dust mites, animal dander, pollen, moulds)

Irritants (Cold air, exercise, smoke, fumes, URTIs)

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5
Q

Diagnosis of asthma on the basis of lung function tests

A

1) decreased baseline
bronchodilator response test, oral steroid trial, serial home peak flow charting

2) Normal baseline
Serial home peak flow measurements must show a drop of 20% post trigger exposure/exercise.

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6
Q

What is an oral steroid trial for asthma?

Describe in three steps

A

Measure FEV1/PEF
Then give 40mg Prednisone PO for 2 weeks
Follow up and assess response

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7
Q

What do you find on examination in an asthmatic?

A

Wheeze
Hyperinflation

OR

Nothing

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8
Q

Occupational history red flags for ?asthma

X6

A

Latex, baking, spray painting, plastics, animals, platinum industries

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9
Q

Medication history red flags for asthma

X3

A

Aspirin
NSAIDS
B-blockers

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10
Q

Benefits of inhalation treatment for asthma

X6

A 
Targets site of disease
Lower dose
Lower systemic absorption
Fewer side effects
Patient can tritrate the dose
Rapid onset
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11
Q

Drawbacks of inhalation treatment for asthma

X4

A

Poor inhaler technique
Cultural suspicion
Patient fear of addiction
Overuse/underuse difficult to monitor

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12
Q

When is it more likely to be COPD as opposed to asthma?

X5

A 
Onset after 50
Significant smoking history >15 PYs
Constant SOB and cough
Slow progression
Poor treatment response
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13
Q

When is it more likely to be asthma as opposed to COPD?

X4

A

Young age of onset
Patient or family history of atopy or asthma
Variation in symptoms: Episodic/ diurnal variation/ day to day variation
Good response to treatment

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14
Q

Other differentials for asthma

A 
Upper airway obstruction
Local bronchial obstruction - e.g. Tumor
Cardiac disease
Bronchiectasis 
Recurrent pulmonary emboli
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15
Q

Name two types of reliever therapy

A

Short acting B2 agonists

Anti-cholanergics

16
Q

Short acting B2 agonists:
Time of onset
Side effects
Example of a drug

A

5-15 minutes
Tremor/palpitations
Salbutamol

17
Q

Anti cholanergics:
Time of onset
Side effects
Example of a drug

A

Within 30 minutes

Urinary retention, worsen closed angle glaucoma, paradoxical bronchospasm, hypersensitivity

18
Q

Name four classes of controller therapy

A

Steroids
Long acting B2 agonists
Leukotriene receptor modifiers
Sustained release theophyllines

19
Q

Steroids
Time of onset
Side effects
Example of a drug

A

2-3 hours
Bruising, thrush, hoarseness
Budeflam (inhaled), prednisone (oral)

20
Q

Long acting B2 agonists:
Length of action,
Dosing interval

A

Provides 12+ hours of bronchodilation

Used BD

21
Q

Leukotriene receptor modifiers:
What TYPES of asthma is this treatment most effective for?
Example

A

Exercise and aspirin induced asthma

Monteleuklast

22
Q 
Sustained release theophyllines
Onset
Side effects
Example
Dangers?
A

30 minute onset
Nausea, diarrhoea, vomiting, dyspepsia, muscle cramps, palpitations, arrythmias
Theophilus, Nuelin SA
Danger - narrow therapeutic index

23
Q

Approach to acute severe asthma

3

A

Assess
First line treatment (15-20) minutes
Assess response to treatment + plan

24
Q

Assessment of acute severe asthma
When do you worry?
X5

A

Pulse > 120
RR > 30
Can’t talk
O2 sats <33% - life threatening

25
Q

First line treatment of an asthma attack

A

Oxygen - face mask 40% to keep sats above 92%
B2 agonists every 2-4 hours via nebuliser or spacer
Steroids 30-60mg PO or IV if vomiting/ can’t swallow

26
Q

Second line treatment of an asthma attack

A

Ipratoproum bromide
IV Magnesium Sulphate
IV Aminophylline
IV Salbutamol

27
Q

When do you refer someone having an asthma attack to a hospital?

A

Inadequate response to Rx within 1-2 hours
If PEFR fails to ⬆️
Prolonged sx (they were struggling for a while before presenting)
Recurrence (within 2 weeks)
High risk patient

28
Q

When do you refer someone having an asthma attack to the ICU?

A

Signs of imminent respiratory arrest

Poor response to initial Rx - PEFR stays below 50%

29
Q

7 signs of imminent respiratory arrest

A 
⬆️PaCO2 - persistent acidosis
Cyanosis 
Exhaustion
Drowsiness
Confusion
Silent chest
Bradycardia
30
Q

Three cardinal features of asthma

A

Variability
Precipitates
REVERSIBILITY

General Medicine (4 decks)

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