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Respiratory > Asthma > Flashcards

Asthma Flashcards

1
Q

What is asthma?

A

A chronic inflammatory condition of the airway

Recurrent episodes of dyspnoea, cough and wheeze caused by airway obstruction

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2
Q

What are the 3 characteristics/features of asthma?

A

Airflow limitation

Airway hyper-responsiveness to stimuli

Inflammation of the bronchi

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3
Q

Is the airway obstruction in asthma reversible?

A

Yes, usually

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4
Q

How is asthma classified?

Two categories.

A

Extrinsic: atopic
- allergens can be identified that are triggering the asthma

Intrinsic:

  • no definite external cause
  • many of these patients are atopic however
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5
Q

When do extrinsic and intrinsic asthma patients usually present?

A

Extrinsic: childhood

Intrinsic: middle age

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6
Q

Is there a genetic influence in asthma?

If so, which genes?

A

Yes

Often in genes involved in sensing pathogens

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7
Q

What is atopy?

A

Syndrome where people develop IgE antibodies against common environmental antigens such as dust, pollen

Atopic people have one or more of:

  • Asthma
  • Eczema
  • Hayfever
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8
Q

What 3 features cause airway narrowing in asthma?

A
  1. Bronchial muscle contraction triggered by stimuli
  2. Mucosal swelling and inflammation
  3. Increased mucus production
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9
Q

In an asthma attack it is harder for the person to breathe in than to breathe out.

True or false?

A

False

It is harder for the person to breathe out that breathe in
Resulting in hyperinflation of the lung

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10
Q

How does the lung become hyper-inflated? And what happens when this happens?

A

In an acute asthma attack it is harder for the person to breathe in than out so the lungs become over filled.

No new air can get in or out so the blood does not receive enough oxygen

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11
Q

What happens to the smooth muscle in the airways in asthma?

A

Inappropriate and excessive contraction, constricting the airways

Hypertrophy and proliferation of the smooth muscle cells, making the airways narrower

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12
Q

What happens to the epithelial cells in the airways in asthma?

A

Metaplasia

Loss of ciliated columnar cells

An increase in the number of goblet cells

Increased basement membrane thickening

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13
Q

What do goblet cells do?

A

Secrete mucus

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14
Q

What is the role of antigen presenting cells (dendritic cells) in asthma?

A

They digest antigens of the allergen and present it to the lymphocytes which then cause inflammation

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15
Q

When the lymphocytes have been triggered by being presented with an antigen, what do they do?

A

They release cytokines (interleukins mainly) which activate and summon mast cells and eosinophils

These continue the immune response causing inflammation

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16
Q

What is the progression from encountering some pollen to developing asthma?

A

Inhale pollen

APCs present antigen to lymphocytes

Immune response occurs

Memory response is formed to the allergen, mediated by IgE

Immune system is now sensitised to the antigen

Everytime the person inhales pollen with this antigen again an immune response will occur

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17
Q

What is the role of mast cells in asthma?

A

They are summoned to the site by lymphocytes (that had been activated by APCs)

Antibodies produced by B cell bind to the mast cells and cause them to degranulate

When mast cells degranulate they release inflammatory mediators such as cytokines and histamine

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18
Q

What is the role of B cells in asthma?

A

They produce antibodies against the antigen

Theses then go on to activate mast cells to degranulate

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19
Q

What does histamine do?

A

Increases the permeability of the capillaries to white blood cells and some proteins

This allows them to engage with pathogen/allergen in the affected tissues

Causes an inflammatory response

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20
Q

What is eosinophilic asthma?

A

A type of asthma that involves eosinophils

Too many eosinophils are produced in the bone marrow

Too many eosinophils are recruited to the airways

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21
Q

In eosinophilic asthma, what causes greater numbers of eosinophils to be produced in the bone marrow?

A

Interleukin 5

22
Q

In eosinophilic asthma, what causes greater numbers of eosinophils to be recruited to the airways?

A

Chemokines

Prostaglandin 2

23
Q

What is the role of eosinophils in asthma?

A

They contribute to airway remodelling and tissue damage

24
Q

What is non-eosinophilic asthma?

A

No eosinophils are involved

Could be neutrophils instead

25
Q

What are the phenotypes of asthma?

A

Eosinophilic

Non-eosinophilic

26
Q

List some causes of asthma attacks?

A 
Cold air
Exercise
Emotion
Allergens
Infection (especially viral)
Smoking
Pollution
NSAIDs
B-blockers
27
Q

How do asthma patients present?

A

Intermittent symptoms

Wheeze
Cough
SOB
Chest tightness
Sputum production
28
Q

When are asthma patients’ symptoms usually worse?

A

At night, usually about 4am

29
Q

What are the 3 Royal College of Physicians questions to ask an asthma patient?

A

Any recent nocturnal waking?

Usual asthma symptoms in the day?

Interference with activities of daily living

30
Q

What should you ask an asthma patient during a GP consultation?

A

Age of onset

Did they have respiratory problems in childhood?

Do they have signs of atopy: eczema, Hayfever

Diurnal variation: worse in early hours of morning?

Disturbed sleep

Exercise tolerance

What is their environment? Any pets, dusty carpet, feather pillows

What is their job? Any allergens there, and do symptoms reduce when they are not at work?

Family history

31
Q

What are the signs of chronic asthma?

A

Tachypnoea
Audible wheeze (polyphonic)
Hyper-inflated chest
Reduced air entry

32
Q

What are the signs of a severe asthma attack?

A

Inability to complete sentences

Pulse over 110bpm

Resps over 25/min

Peak flow 33-50% of predicted

33
Q

What are the signs of a life threatening attack?

What about near fatal?

A

Peak flow < 33%
SpO2 < 92%
PaO2 < 8kPa

Silent chest
Reduced GCS
Exhaustion = poor resp effort
Cyanosis
Hypotension

Near fatal = PaCO2 raised

34
Q

What are the signs of a moderate asthma attack?

A

Peak flow over 50% of predicted

No signs of severe asthma

35
Q

How do you distinguish asthma from COPD?

A

COPD:

Later onset and usually smoking related

Relentless, progressive SOB + wheeze

Less diurnal and day-to-day variation

36
Q

Investigations for asthma.

A

Blood: eosinophils, O2 + CO2 stats

Tests for atopy: skin prick tests

CXR: exclude infection or pneumothorax

Oxygen saturations

Lung function tests:

  • Peak flow
  • Spirometry
  • (Response to a challenge agent)
  • Reversibility testing
37
Q

What information can you get from spirometry?

A

FEV1 + FVC

38
Q

What is FEV1?

A

Forced expiratory volume in 1 second

39
Q

What is FVC?

A

Forced vital capacity: total amount of air exhaled during FEV test (all 3 seconds of exhalation)

40
Q

What challenge agents are used in the response to a challenge agent test?

A

Mannitol: a bronchial irritant

Methacholine: a bronchoconstrictor

41
Q

What is a response to challenge agent test?

What does it help diagnose

A

Airways are irritated and you watch what happens to the person

Helps diagnose exercise triggered asthma

42
Q

What is reversibility testing?

A

Looks to see if there is an increase in lung capacity with bronchodilators or anti-inflammatory treatment

43
Q

What is the differential diagnosis of wheeze, SOB, cough, etc.

A

Pulmonary oedema

COPD

Airway obstruction: tumour, foreign body

Pneumothorax

Pulmonary embolism

Bronchiectasis

44
Q

Which asthmatics are at risk of death?

A

Those on at least 3 classes of treatment

Recent admission/frequent hospital attendance

Previous near fatal disease

Brittle asthma

Psychosocial factors

45
Q

What is Brittle asthma?

A

Type of asthma where they get recurrent, severe attacks

46
Q

Treatment of chronic asthma?

A

Avoid triggers
Use peak flow meter every day
Educate in case of emergency

Step up + down drug treatment:

  1. SABA
  2. SABA + LD ICS
  3. SABA + LD ICS + LTRA
  4. SABA + LD ICS + (LTRA if helpful) + LABA
  5. SABA + (LTRA) + MART (with LD ICS)
  6. SABA + (LTRA) + MART (with MD ICS)
  7. SABA + (LTRA) + HD ICS + LAMA/theophylline + REFER
47
Q

Which oral steroid is usually used?

A

Prednisolone

48
Q

Which inhaled steroid is usually used?

A

Beclometasone

49
Q

Management of an acute asthma attack.

A

Salbutamol nebulised with oxygen

Prednisolone

Monitor O2 stats, heart and resp rate

Admit to ICE/HDU if in need of ventilation

50
Q

What is the red-flag sign that you need to quickly admit to ITU/HDU and ventilate the patient?

A

Raised CO2 levels

Respiratory (17 decks)

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