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Respiratory > Asthma > Flashcards

Asthma Flashcards

1
Q

What are primary and secondary factors to help determine the severity of an asthma attack?

A

Primary: general appearance/ mental state, work of breathing
Secondary: initial SaO2 in RA, HR, ability to speak

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2
Q

What is asthma?

A

A cough or wheeze associated with heightened airway responsiveness to irritants

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3
Q

What is the pathophysiology of asthma?

A
  1. infiltration of mucosa with inflammatory cells (especially eosinophils)
  2. oedema of the membrane, thickening of the basement membrane
  3. damaged mucosal epithelium
  4. hypertrophy of mucus glands with increased mucus secretion
  5. smooth muscle constriction
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4
Q

What are some common triggers of asthma (A-J)?

A 
A: allergens- pollens, dander,  dust mites
B: bronchial infection
C: cold air
D: drugs- aspirin, NSAIDs, B-blockers
E: emotion- stress, laughter
F: food- sodium metabisulphate
G: gastrooesophageal reflux
H: hormones- pregnancy, menstruation
I: irritants- smoke, perfumes, smells
J: job- wood dust, flour dust, animal dander
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5
Q

What are the 4 classic features of asthma?

A
  1. wheezing
  2. cough (especially at night)
  3. tightness in the chest
  4. breathlessness
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6
Q

At what age should spirometry be performed?

A

Over age 6

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7
Q

What are some investigations to diagnose and manage asthma?

A
  1. spirometry: obstructive if FEV1/FVC 15% in FEV1 and PEFR
  2. inhalation challenge (histamine, methacholine, hypertonic saline, mannitol) to test airway reactivity
  3. exercise challenge
  4. allergy testing
  5. CXR in first episode of asthma of if symptoms not explained by asthma
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8
Q

What are some reasons for suboptimal asthma control?

A
  1. Poor compliance
  2. inefficient use of inhalers
  3. suboptimal therapy especially no preventers
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9
Q

What are the aims of management of asthma?

A
  • absent or minimal daytime symptoms
  • no nocturnal symptoms
  • achieve minimal drug use, minimal side effects
  • reduce risk of fatal attacks
  • reduce risk of developing irreversible abnormal lung function
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10
Q

What are the 6 steps of the National Asthma Plan?

A
  1. assess severity
  2. achieve best lung function
  3. avoid triggers
  4. maintain best lung function with optimal medication
  5. written asthma action plan
  6. educate and review regularly
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11
Q

What are some non pharmacological ways to improve management of asthma?

A
  • identify and avoid triggers
  • physiotherapy
  • keep fit and do regular exercise
  • keep to an ideal weight
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12
Q

What is the difference between a preventer, a reliever and a symptom controller?

A

preventer: antiinflammatory
reliever: bronchodilator
symptom controller: long acting b-agonist

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13
Q

How is asthma classified?

A

intermittent
mild persistent
moderate persistent
severe persistent

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14
Q

In intermittent asthma what are the

  • symptoms before treatment
  • lung function
  • recommended treatment
A
  • episodic symptoms < weekly, night symptoms 80%
  • SABA PRN
  • regular ICS not required. Add preventer if >3 SABA/ week
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15
Q

In mild persistent asthma what are the

  • symptoms before treatment
  • lung function
  • recommended treatment
A
  • symptoms > weekly but not every day, night symptoms >2 per month, regular symptoms with exercise
  • > 80%
  • SABA PRN
  • start low dose ICS and increase dose if >2 SABA 2-3 times daily
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16
Q

In moderate persistent asthma what are the

  • symptoms before treatment
  • lung function
  • recommended treatment
A
  • daily symptoms, night symptoms > weekly, several known trigger apart from asthma
  • 60-80%
  • LABA + SABA PRN
  • low to moderate ICS
17
Q

In severe persistent asthma what are the

  • symptoms before treatment
  • lung function
  • recommended treatment
A
  • daily symptoms, wakes frequently at night with cough/ wheeze, chest tightness on waking, limitation on physical activity
  • <60%
  • LABA + SABA
  • maximal ICS
18
Q

What are some side effects of ICS

A
  • oropharyngeal candidiasis, dysphonia
  • bronchial irritation: cough
  • adrenal suppression (doses 2000mcg daily)
19
Q

How do you explain to patients the correct use of a MDI?

A
  1. remove cap and shake vigorously for 1-2 seconds. Hold cannister upright
  2. place mouthpiece between teeth and close lips around it
  3. breath out
  4. tilt your head back and chin up
  5. breathe in through mouth and press puffer at the same time. Do not breathe in through nose
  6. remove puffer from mouth and hold breath for approx 10 seconds then breath out
  7. breath normally for 1 minute then repeat if require

Respiratory (13 decks)

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