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Respiratory > Asthma > Flashcards

Asthma Flashcards

1
Q

What is asthma?

A

Chronic inflammatory disorder of the airways resulting in episodes of reversible bronchospasm causing airflow obstruction. ; ass/w airway hyper-responsiveness to endogenous or exogenous stimuli.

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2
Q

Epidemiology of asthma?

A
  • Common 10-15% children
  • Most children significantly improve in adolescence
  • Often FHx of atopy
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3
Q

What is the pathophysiology of asthma progression?

A

Airway obstruction –> V/Q mismatch –> hypoxemia –> increased ventilation –> decreased PaCO2 –> increased pH and muscle fatigue –> decreased ventilation –> decreased PaCO2 and pH.

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4
Q

What are the triggers for asthma?

A
  • URTIs
  • Allergens
  • Irritants
  • Drugs (NSAIDS, Bblockers)
  • Preservatives (sulphites, MSG)
  • Other (cold air, exercise, emotion)
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5
Q

What are the symptoms of asthma?

A

-Dyspnoea esp nocturnal
-Wheezing
-Chest tightness
-Cough (dry; esp nocturnal)
-Sputum (some)
REVERSIBLE - good and bad days.

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6
Q

Red flags in asthma?

A
  • Severe tachypnea / tachycardia
  • Respiratory muscle fatigue
  • Diminished expiratory effort
  • Cyanosis
  • Silent chest
  • Decreased LOC
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7
Q

Ix in asthma?

A
  • SaO2
  • ABGs
  • RFTs (when pt stable)
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8
Q

Explain the changes in PaCO2 in asthma attack?

A
  • Decreased: mild asthma due to hyperventilation
  • Normal or increased: ominous sign -> pt no longer able to hyperventilate (worsened airway obstruction or resp muscle fatigue)
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9
Q

Broad management of asthma?

A
  • Avoid tigers
  • Pt education e.g. asthma action plan
  • Pharmacological: symptomatic and preventative
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10
Q

What are the symptomatic Rx for asthma?

A
  • SABA / LABA
  • Anticholinergics
  • Oral steroids
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11
Q

What are the long term/preventative Rx for asthma?

A
  • Inhaled/oral corticosteroids
  • Anti-allergic agents
  • LABA
  • Menthylxanthine
  • Anti IgE Abs
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12
Q

What is the emergency management of asthma?

A
  1. Oxygen
  2. Inhaled B2 agonist regularly
  3. Systemic steroids PO prednisolone or IV hydrocortisone
  4. Add anticholinergic
  5. Rapid sequence intubation in life threatening cases
  6. SC/IV adrenaline, IV salbutamol if unresponsive
  7. Corticosteroids therapy at d/c
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13
Q

What is the pathophysiology of acute asthma?

A

-Mediator release from mast cells and eosinophils
(histamine, PGs, LTs and cytokines) in response to allergen
This produces bronchoconstriction, oedema and mucous.

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14
Q

What are the features of airway remodelling in asthma?

A
  • Smooth muscle and goblet cell hyperplasia

- Thickening of BM

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15
Q

What is the outcome of the airway remodelling in asthma?

A

Airflow limitation and airway hyperresponsiveness (due to increased mucous secretion, oedema and SM contraction).

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16
Q

Signs in asthma attach?

A
  • Anxiety
  • Tachypnoea
  • Cyanosis
  • Increased WOB and hyperinflation (due to bronchospasm)
  • Accessory muscle use
  • Susternal intercostal retraction
  • Prolonged expiratory phase with wheeze
  • Reduced breath sounds
  • Pulsus paradoxus
17
Q

How is asthma diagnosed?

A

PEF: 20% variation day to day OR

-Spirometry: 200mL and 12% improvement with bronchodilator

18
Q

Investigation if spirometry unremarkable?

A

Broncho provocation testing: measures pathophsyological features of bronchial hyper responsiveness.

19
Q

What aerate types of broncho provocation testing?

A

Direct: methacholine, histamine
Indirect: hypertonic saline, eucapneic hyperventilation, mannitol

20
Q

What are alternative causes of wheeze?

A
  • Asthma
  • Bronchitis
  • COPD exac
  • Vocal cord dysfunction
  • Obstructing endobronchial lesion (may have focal wheeze)
21
Q

What are the goals of asthma treatment?

A
  • Control symptoms
  • Prevent exacerbations
  • Maximise lung function and prevent decline
  • Maintain normal activity
  • Lowest dose Rx to achieve suitable control and minimise AEx
22
Q

What are the local AEx of ICS asthma therapy?

A

-Hoarse voice
-Thrush
Need to rinse mouth after

23
Q

What are the reasons for poor compliance with asthma Rx?

A
  • Symptom remission
  • Multiple Rx
  • Chronicity of asthma
  • Cost
  • Poor understanding
  • Cultural issues
24
Q

What are the RFx for increased risk of death from asthma?

A
  • previous life threatening ep
  • recent hospitalisation for asthma
  • poor psychosocial supports
  • poor adherence to preventative treatments
  • difficulty accessing treatment

Respiratory (17 decks)

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