Asthma Flashcards
Pathogenesis
Inflammation Mast cells Eosinophils Mucus plugs Increase airway tone Airway remodelling
What lung function tests can be used to diagnose Asthma?
Spirometry and peak expiratory flow
Asthma presentation
Wheezing / coughing Chest tightening Shortness of breath Childhood Triggers
What is immediate phase bronchoconstriction?
Bronchospasm and wheezing
What is late phase bronchospasm?
Further inflammation and airway obstruction
Cough and sputum production
What are the aims of asthma treatment?
No daytime symptoms No night time waking due to asthma No need for rescue medication No exacerbations No limitations on activity including exercise Normal lung function Minimal side effects
Steps of chronic asthma level
1 SABA 2 inhaled corticosteroid or B2 agonist 3 LABA 4 theophylline 5 oral steroid tablets
Why do we use step DOWN treatment?
Over treatment is well documented in asthma
Increase risk of adverse effects
Increasing use of combo inhalers keep patients at step 3 or above
Titrate downwards –> marginal additional benefit for higher steroid doses
Use lowest effective steroid dose
Eliminate use of long term adverse effects
How to treat acute asthma exacerbation?
Oxygen SABA Ipratropium bromide Corticosteroids Magnesium Aminophylline
Diagnosis and treatment of MODERATE acute asthma
Able to talk
Pulse 110 bps
Peak flow >50% predicted
Treat at home or in surgery
Inhaled SABA via spacer or nebuliser
Prednisolone 40mg for 3-5 days
Diagnosis and treatment of SEVERE acute asthma
Cannot complete sentences in one breath
Respiration is > 25 bpm
Pulse > 100 bpm
Peak flow 33-50% of predicted
Start treatment and send to hospital immediately
High flow oxygen
Inhaled SABA via spacer or nebuliser
Prednisolone as per moderate or IV Hydrocortisone
Consider IV beta2agonist, aminophylline or magnesium sulphate
Diagnosis of LIFE THREATENING acute asthma
Treatment as with moderate…
Silent chest, feeble respiratory effort
Hypotension, bradycardia, arrythmias
Peak flow
Explain personalised care
How to recognise exacerbations Advice on prompt use of SABAs and oral corticosteroids Monitoring response to medicines Contact info Follow up to assess asthma control
Definition of asthma
Chronic inflammatory disorder in susceptible individuals
Often reversible - either spontaneously or with treatment
