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Respiratory > Asthma > Flashcards

Asthma Flashcards

1
Q

What percentage of children have asthma?

A

10-15%

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2
Q

In children is asthma more common in boys or girls?

A

Boys

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3
Q

What percentage of adults have asthma?

A

5-10%

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4
Q

In adults is asthma more common in men or women?

A

Women

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5
Q

Define asthma

A

An increased responsiveness of the trachea and bronchi to various stimuli and manifests by a widespread narrowing of the airway that changes in severity either spontaneously or as a result of therapy

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6
Q

What is atop?

A

An IgE response to an allergen such as food or pollen

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7
Q

Which type of atopy is more influential?

A

Maternal atopy

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8
Q

Which genes are associated with genetic atopy?

A

ADAM 33 - airway genes

Immune response genes

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9
Q

What are the proven risk factors for asthma?

A

Genetic atopy
Occupation
Smoking

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10
Q

Why do airways narrow in asthma?

A

Because the airway itself thickens as well as a build up of mucous and cellular debris

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11
Q

What are the possible risk factors for asthma?

A

Obesity
Diet
Reduced exposure to microbes/microbial products
Chemical household products - indoor pollution

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12
Q

Which occupation has the highest rates of asthma?

A

Bakers because of the wheat protein and the grain mites in the grains

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13
Q

What are the problems that are risk factors for occupational asthma?

A 
Isocyanates
Rosin  
Lab animals - rodent urine proteins
Grains - wheat proteins, grain mites
Enzymes - subtilisn, amylase 
Drugs - antibiotics, salbutamol 
Crustaceans
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14
Q

What is the grandmother effect with smoking?

A

The oocytes in the baby of a smoker are modified by the smoking so the baby will have children that can be effected by their grandmothers smoking

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15
Q

What are some environmental allergens?

A

House dust mites
Cats
Grass Pollen

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16
Q

What are the symptoms of asthma?

A 
Wheeze 
Dyspnoea 
Chest tightness
Paroxysmal coughing, usually dry 
Sputum
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17
Q

What is dyspnoea?

A

Shortness of breath

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18
Q

What is paroxysmal coughing?

A

A coughing fit

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19
Q

What is the key characteristic of asthma in adults?

A

Evidence of variable symptoms coming at different times

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20
Q

What signs can help rule out asthma?

A 
Clubbing 
Stridor 
Asymmetrical expansion 
Dull percussion note
Crepitations (crackling or rattling sound)
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21
Q

What are the signs to look for in asthma?

A

Hyper-expanded chest
Tachypnoea (abnormally rapid breathing)
Polyphonic wheezes
Hyper-resonant percussion notes

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22
Q

How can variable airflow obstruction be checked?

A

Using a peak flow chart for a period of time

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23
Q

For children what is the rule to follow for diagnosing asthma?

A

No wheeze, no asthma

24
Q

What are the drugs used to treat asthma?

A

Bronchodilators

25
Q

What are the main types of bronchodilators?

A

Long/Short acting beta-2 agonists
Long/Short acting antimuscarinics
Long/Short acting theophylines

26
Q

What drugs shouldn’t be used to treat asthma?

A 
Beta blockers 
NSAIDS 
Aspirin 
Sedatives
Strong opiates
27
Q

What is the difference in drug treatment between chronic asthma and an acute asthma attack?

A

The delivery of the drug

28
Q

What are the different types of inhalers?

A

Meter dose inhaler (pMDI)
pMDI with spacer
Dry powder inhaler (DPI)

29
Q

Give examples of short acting Beta-2 agonists

A

Salbutamol

Terbutaline

30
Q

What do corticosteroids do?

A

To reduce inflammation and suppress the immune system

31
Q

What are corticosteroids used for in the treatment of asthma?

A

They are preventers that are taken regularly to manage symptoms of asthma

32
Q

Name the different types of inhaled corticosteroids available

A 
Beclomethasone 
Budesonide 
Fluticasone 
Ciclesonide 
Mometasone
33
Q

When do you start ICS?

A

Using inhaled β2 agonist (“Reliever”) x3/week or more
Waking one night a week or more due to asthma
Requiring oral steroid for an exacerbation in the past 2 years
Symptomatic x3/week or more

34
Q

What are common side effects of inhaled long term steroids?

A

Dysphonia

Oropharyngeal candidiasis

35
Q

What is the progression when treating asthma?

A
  1. Short acting beta-2 agonist
  2. Low dose ICS
  3. Low dose ICS + LABA
  4. Increase ICS dose and possibly add another therapy
  5. Increase ICS to high dose and possibly add 4th drug
  6. Use daily steroids and high dose of ICS
36
Q

Name ICS + LABA medication

A 
Fostair 
Symbicort 
DuoResp SpiroMax 
Flutiform 
Seretide 
Relvar Ellipta
37
Q

What is a LTRA?

A

Leukotriene receptor antagonist

38
Q

What are the two types of LTRAs used?

A

Montelukast

Zafirlukast

39
Q

What is theophylline?

A

Non-specific phosphodiesterase inhibitor and adenosine receptor antagonist

40
Q

Name a LAMA?

A

Tiotropium bromide

41
Q

What is the main long term oral steroid used?

A

Prednisolone

42
Q

How should long term oral steroids be prescribed?

A

Aim for the lowest oral dose that controls symptoms

43
Q

What can be given to patients who have are on long term steroids and have high IgE levels?

A

Omalizumab - anti-IgE

44
Q

What can be given when there is poor asthma control with blood eosinophilia?

A

Mepolizumab - anti-interleukin-5

45
Q

What immunosuppressive drugs can be used as a last resort?

A

Methotrexate
Ciclosporin
Oral Gold

46
Q

What are the non-pharmacological treatments for asthma?

A 
Patient Education and Self management plans
Inhaler technique
Smoking cessation
Flu/Pneumococcal vaccinations
Allergen avoidance 
Bronchial thermoplasty 
Dealing with co-morbidities
47
Q

How is control of asthma measured in children?

A

Short acting beta-2 agonist / week
Absence school/nursery
Nocturnal symptoms/week
Excertional symptoms/week

48
Q

What is the difference in drug treatment between children and adults?

A

In children the maximum dose of ICS is 800 micrograms, no oral B2 tablets and LTRA is the first line preventer in under 5s

49
Q

What is the progression when treating asthma in children?

A
  1. Short acting B2 agonist as required
  2. Very low dose ICS or LTRA <5
  3. Add LABA >5 or add LTRA <5
  4. Increase ICS to low dose or trial other therapy
  5. Increase ICS to medium dose or add 4th drug
  6. Daily steroid tablet in lowest dose and consider other treatments
50
Q

With children when should you step up treatment?

A

Using reliever 3x/week or more

Symptomatic 3x/week or more or waking up one night a week

51
Q

Which type of ICS should be avoided?

A

Fluticasone

52
Q

What has to be done when using LABA?

A

Do not use without ICS

Use a fixed dose inhaler

53
Q

What should always be used with an inhaler?

A

A spacer

54
Q

How should steroids be used in asthma treatment?

A

Chronic - Inhaled steroids

Acute - Oral steroids

55
Q

Who can use dry powder devices?

A

They are licence for over 5s but under 8s cannot use them

Respiratory (27 decks)

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