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Respiratory: Asthma > Asthma > Flashcards

Asthma Flashcards

1
Q

what type of hypersensitivity reaction is asthma?

A

type 1 hypersensitivity

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2
Q

what is the cascade in asthma?

A

genetic predisposition + trigger factor (viral, allergen, chemicals) leads to airway inflammation (mediators-histamine, leukotrienes) which leads to twitchy smooth muscle

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3
Q

what do intermittent attacks of bronchoconstriction cause?

A
  • tight chest
  • wheezing
  • difficulty in breathing
  • cough
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4
Q

what are the pathological changes that result from chronic asthma?

A
  1. increased mass of smooth muscle (hyperplasia and hypertrophy)
  2. accumulation of interstitial fluid (oedema)
  3. increased secretion of mucus
  4. epithelial damage (exposing sensory nerve endings)
  5. sub-epithelial fibrosis
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5
Q

what is the main cell that causes inflammation in asthma?

A

the eosinophil

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6
Q

why do you get the wheeze?

A

because once the diameter of the bronchus is infolded the airflow changes from a smooth airflow to a turbulent airflow

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7
Q

what happens to the FEV1 and PEFR in asthma? and why?

A

decrease in both FEV1 and PEFR

  • Airway narrowing by inflammation and bronchoconstriction increase airway resistance
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8
Q

what causes bronchial hyper-responsiveness in asthma ?

A

epithelial damage, exposing sensory nerve endings (c-fibres, irritant receptors) contributes to increased sensitivity of the airways to bronchoconstrictor influences (and may cause neurogenic inflammation by the release of various peptides)

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9
Q

what happens in an immediate attack?

A

mainly bronchospasm but some acute inflammation - IgE mediated

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10
Q

what happens in the delayed phase?

A

inflammatory reaction

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11
Q

what type of hypersensitivity reaction are the early phase and late phase of asthma attack?

A

type 1 - early phase

type 4 - late phase

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12
Q

what intrinsic triggers can cause asthma?

A

exercise and cold

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13
Q

what extrinsic triggers can cause asthma?

A

drugs, chemicals, smoke, dust, animal dander, fungi, viral infection

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14
Q

what are the symptoms of asthma?

A

Chest tightness
Wheeze due to turbulent flow
Dry cough
Breathlessness (worse at night)

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15
Q

what are the signs of asthma?

A

episodic

diurnal variability :
a diurnal variability in PEF of more than 20% is considered diagnostic of asthma

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16
Q

what causes the diurnal variability?

A

this is because of the eosinophilic inflammation and things get activated at night

17
Q

what investigations should be done?

A

lung function tests

  • allergen skin prick test
  • bronchial challenge testing (histamine and methacholine)
  • exercise testing
  • CO transfer
  • reversibility due to inhaled salbutamol over 15%
  • diurnal variation in peak flow rate
18
Q

what happens to PEFR in asthma and what are the levels of severity?

A

decreased PEF: mod

19
Q

what happens to the FEV1 and the FVC?

A

FEV1 decreased and FVC remains normal - obstructive pattern

20
Q

what happens to gas transfer in asthma?

A

stays normal

21
Q

what is not uncommon in spirometry?

A

it is not uncommon for patients whose symptoms suggestive of asthma to have normal lung function

22
Q

why are methacholine/histmine/mannitol used in bronchial challenge testing?

A

they are markers of airwy hyper-responsiveness

  • concentration to produce 20% ↓ FEV1
23
Q

why are allergens/chemicals used to in bronchial challenge testing?

A

to diagnose occupational asthma

24
Q

what pattern would be seen in exercise testing for asthma?

A

decreased FEV1 or PEF post exercise in asthma

25
Q

what is step 1 in the treatment of asthma ?

A

inhaled short acting beta agonist - for mild intermittent asthma

26
Q

what is step 2 in the treatment of asthma ? regular preventer therapy

A

add inhaled corticosteroid 200-800 microg/day

- 400 mg is an appropriate dose for many patients

27
Q

what is step 3 in the treatment of asthma ?

initial add on therapy

A
  1. add inhaled LABA
  2. assess control of asthma
    - good response to LABA - continue LABA
    - benefit from LABA but control still inadequate: continue LABA and increase ICS dose to 800
    - no response to LABA: stop LABA and increase ICS to 800. If still inadequate add other therapy like LTR or SR theophylline
28
Q

what is step 4 in the treatment of asthma ?

persistent poor control

A

consider:

  1. increasing dose of ICS to 2000
  2. addition of 4th drug e.g. LTR or theophylline
29
Q

what is step 5 in the treatment of asthma ?

continuous or frequent use of oral steroids

A

use daily steroid tablet at lowest dose providing adequate control

maintain high dose ICS

consider other treatments

30
Q

what are the treatments for acute asthma (O SHIT MAn)

A 
Oxygen (40-60%)
Salbutamol (nebulised)
Hydrocortisone (IV)
Ipratropium (nebulised)
Theophylline (oral)
Magnesium sulphate (IV)
Anaesthetist!

Respiratory: Asthma (2 decks)

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