Asthma Flashcards
with regards to epidemiology what is the prevalence of asthma in the adult welsh population
1:12 welsh adults
according to epidemiological studies list 2 environmental factors that may increase your risk of developing asthma
Increased risk • Caesarian delivery? • Childhood antibiotic use • Childhood use of paracetamol? • Exposure allergen • Sedentary life style • Obesity • Maternal smoking • Pollution
list three pathological features of asthma that may be found at post mortem
Any of the following • Inflammation of bronchial wall: eosinophilic • Mucus plugging • Airway remodelling: – Airway wall thickening: 50-300% (Bronchial smooth muscle hypertrophy \+ airway oedema) – Mucus gland hyperplasia – Loss of surface epithelium – Sub-epithelial fibrosis - thickening of basement membrane
list 2 mediators released by mast cells which cause bronchoconstriction clinically
Histamine, Prostaglandin D2, Leukotrienes (D4, E4)
T-helper 2 lymphocytes release the cytokine IL-5 which promtoes the differentiation of which inflammatory cell type
Eosinophils
in some individuals NSAIDs may worsen asthma. Which enzyme does this class of medication inhibit
COX (II)
Mr X is 34y/o asthmatic on inhaled budesonide and PRN salbutamol. which step of the asthma ladder is he currently on?
Step 2: low dose inhaled steroid + PRN B2 agonist
Mr X is 34y/o asthmatic on inhaled budesonide and PRN salbutamol. He attends your surgery as he is not sleeping at night due to cough and wheeze. If you were to increase his treatment name a class of drugs that you would add to his therapy
Try LABA first and if ineffective consider increasing ICS
then theophylline or leukotriene receptor antagonist
You are the A&E SHO on call. Miss B is a known
asthmatic who presents with cough and SOB. On arrival
the paramedics show you her ambulance card.
Observations are as follows. Pulse 120, RR 26, Sats
94% on air. When you review her she has marked
expiratory wheeze and is not able to talk full sentences.
Grade her asthma severity
severe
You are the A&E SHO on call. Miss B is a known
asthmatic who presents with cough and SOB. On arrival
the paramedics show you her ambulance card.
Observations are as follows. Pulse 120, RR 26, Sats
94% on air. When you review her she has marked
expiratory wheeze and is not able to talk full sentences.
name 3 medications that you would consider starting her on
Salbutamol 5mg nebulised, Ipratropium bromide 500mcg
nebulised, Prednisolone 40mg od po
Parameter Value Normal range pH 7.35 (7.35-7.45) pCO2 6.0 4.5-6kPA pO2 10 11.5.- 13 BE 1 -1 /+1 Bicarb 25 24/27
what concerns you about this blood gas
normal pCO2 worsening hypoxia
Parameter Value Normal range pH 7.35 (7.35-7.45) pCO2 6.0 4.5-6kPA pO2 10 11.5.- 13 BE 1 -1 /+1 Bicarb 25 24/27
ITU are contacted, list 2 other therapy that you might consider
IV magnesium sulphate
IV aminophylline/IV salbutamol
Mrs A is a 44 year old atopic asthmatic. She currently
taking symbicort tubohaler 400/12 (eformoterol +
budesonide 400). She is also taking uniphyllin
(theophylline).
which step of the asthma ladder is this patient currently on
Step 4: on high dose inhaled steroids, LABA and
theophylline
which enzyme do theophylline tablets inhibit
Phosphodiesterase: inhibiting the breakdown of cAMP
state the side effects you are most likely to see in a patient taking a beclometasone inhaler
Sore throat
Candidiasis
Hoarse voice
can be avoided with the use of spacers/improving technique or rinsing mouth out after
In patients taking 1mg/day beclometasone (or equivalent) we should
also monitor carefully for systemic side effects
for approximately how long would you espect to see the bronchodilation effects of salmeterol
12 hours
which of the inflammatory mediators does montelukast block from reaching its receptor
leukotriene
name a drug or condition which can increase the half life of theophylline? and what symptoms could this cause?
Hepatic cirrhosis CHF Acute pulmonary oedema Erythromycin Fluconazole Other drugs also inhibit metabolism of theophylline – check Appendix 1 of BNF for details Symptoms of toxicity include N&V, arrhythmias, restlessness, convulsions, coma
mary has come to her GP and described worsening asthma symptoms, what would you discuss with her before making changes to her drug treatment
Possible triggers for worsening symptoms
Inhaler technique and compliance
Jack, aged 31years is using a Seretide 125 evohaler
(fluticasone and salmeterol) regularly and a salbutamol
inhaler when required. His asthma has been well
controlled for many years, with him rarely using his
salbutamol inhaler and he has come for a review of his
treatment.
You decide that stepping down his treatment would be appropriate. Which of his drugs should be discontinued?
Salmeterol
But patient should remain on fluticasone and when required
salbutamol so no reduction in dose count
T/F In children with wheeze:
A) Bronchiolitis only affects children over 2 years of age
B) Haemoptysis is a common symptom of childhood
asthma
C) Congenital lung abnormalities can present as old as 5
years age
D) Toddlers are the commonest age group for inhaled
foreign bodies
E) Nocturnal cough is a sign of asthma
F) A child who is not wheezing by 3 years of age will not
develop asthma
In children with wheeze
C) Congenital lung abnormalities can present as old as 5
years age
D) Toddlers are the commonest age group for inhaled
foreign bodies
E) Nocturnal cough is a sign of asthma
T/F Exercise and children:
A) Cross country running is usually more of a problem
than football for children with asthma
B) A high organic content or insufficient chlorine in a
swimming pool can trigger asthma
C) Swimming is well tolerated in most children with
asthma
D) Warming up before exercise can have a ‘protective
effect’ for children with asthma
E) Professional athletes do not have asthma
A) Cross country running is usually more of a problem
than football for children with asthma
B) A high organic content or insufficient chlorine in a
swimming pool can trigger asthma
C) Swimming is well tolerated in most children with
asthma
D) Warming up before exercise can have a ‘protective
effect’ for children with asthma
T/F In acute asthma in children:
A) 10-12 puffs of salbutamol via a spacer is usually as
effective as the appropriate dose via a nebulizer in
acute asthma in children
B) Oral steroids are not given in acute asthma preteenage
years due to their effect on growth
C) Teachers have a legal requirement to give children
their medication in school
D) Stress/emotion is not a trigger in primary school
children
E) Toddlers with a tight chest may complain of ‘tummy
ache’
In acute asthma in children:
A) 10-12 puffs of salbutamol via a spacer is usually as
effective as the appropriate dose via a nebulizer in
acute asthma in children
E) Toddlers with a tight chest may complain of ‘tummy
ache’
T/F Inhalers/PEFRs in children:
A) Washing and air drying a spacer in ‘fairy’ washing up
liquid significantly reduces its static
B) An MDI and spacer is the first choice for inhaled
treatment in children under 5 years.
C) A dry powder inhaler is first choice for inhaled steroid
treatment in children aged 6 – 12 years
D) Children 3 years and over are able to give reliable
PEFRs
E) An MDI directly into the mouth should be used for
bronchodilators in Teenagers
F) PEFRs in children are charted against their height
Inhalers/PEFRs in children:
A) Washing and air drying a spacer in ‘fairy’ washing up
liquid significantly reduces its static
B) An MDI and spacer is the first choice for inhaled
treatment in children under 5 years
F) PEFRs in children are charted against their height
which factors reduce risk of asthma development
Reduced Risk • Vaginal delivery • Breast feeding • Infection: “The Hygiene Hypothesis” • Exposure to rural environment • Increase antioxidants
