Asthma Flashcards
What are the aetiologies of asthma?
Atopy and allergy
Genetics
Environmental factors
Drugs
What is the pathophysiology of asthma?
Disease of the lung airway
Airway inflammation mediation by immune system
What are the symptoms of asthma?
Wheeze SOB Chest tightness Cough Occasional sputum Evidence of variable symptoms
What are some past medical history indicators of asthma?
Childhood asthma
Bronchitis
Eczema
Hayfever
What are the essential investigations for asthma?
Evidence of airflow obstruction and variability SPIROMETRY - less than 0.7 ratio PEFR - variability CO TRANSFER TEST RESPONSE TO ICS and BRONCHODILATORS
What are useful investigations?
CHEST XRAY
FBC
SKIN PRICK TESTS
TOTAL IGE
What is the 1st step of management in adults?
Inhaled SABA
What is the 2nd step in adults?
Add inhaled corticosteroids of dose 200-800micrograms
If using SABA 3x a week, waking one night a week, sub-normal exercise tolerance, steroids for exacerbation in past 2 years
What is the 3rd step in adults?
Add LABA and assess control
If good control then continue
If benefit but not adequate control then continue and increase ICS dose to 800
If no response, stop LABA and increase steroid
What is the 4th step in adults?
Increasing steroid up to 2000micrograms per day
Consider trial of leukotrine receptor antagonist or SR theophylline
What is the 5th step in adults?
Use a daily steroid table
Maintain high dose ICS
Refer to specialist
What is step 1 in children?
SABA
What is step 2 in children?
ICS 200-400 micrograms or LTRA in under 5a
What is step 3 in children?
LABA as in adults
What is step 4 in under 5s?
Refer for confirmation of diagnosis