Asthma Flashcards
What is asthma always associated with?
A wheeze
Why does a wheeze occur with asthma?
Bronchoconstriction, airwall thickening and luminal secretions.
How can you tell that the airway obstruction is asthma and not something else?
it should be a variable obstruction, that responds to treatment.
How does paediatric asthma differ to adult asthma?
what gender its common differs (boys/women)
Doesn’t tend to be occupation linked
Can be more severe in children
How common is asthma?
Very - 1,000,000 in UK
100,000 in scotland.
Is the prevalence of paediatric asthma increasing or decreasing?
increasing
Asthma is caused by ‘multiple hits’. Name some of these hits.
Infant onset, childhood onset, adult onset, excertional, occupational, genes, abnormal lungs, later exposure to rhinovirus, exercise and smoking.
How can asthma be considered so inconsistent?
varies in severity, symptoms, onset ages, triggers.
Why is childhood asthma so difficult to diagnose?
patient may not be wheezing at the time,
cannot use stethoscope,
spirometry insignificant (varying results in all children without asthma),
Rattle/stridor mistaken for wheeze. (55% is not really asthma)
What is an isolated cough more likely to be?
bronchitis (wet cough), habitual cough
Is there a lower age limit on asthma?
No - but under 18 months its more likely an infection.
How do you treat asthma?
Inhaled corticosteroids
salbutamol
Whats atopy? (doesnt cause asthma - but is linked)
tendency to be ‘hyper allergic’
Why may a child’s wheeze be wise than an adults wheeze?
They have smaller airways anyway
whats the difference between asthma and viral induced wheeze?
Completely different conditions but may present the same symptoms and should both be treated.
What could be misdiagnosed as a wheeze?
Rattle, steror
What are the symptoms of bronchitis?
loose, rattly cough, noisy breathing, post tussive vomiting (vomiting caused by cough)
NO WHEEZE
what are the symptoms of pertussis?
Whooping cough Coughing fits Vomiting Colour change Petechiae (wee purple spots)
What is the definition of asthma?
Increased responsiveness of the trachea and bronchi to various stimulus - more likely in the presence of an irritant. Widespread narrowing that changes in severity either spontaneously or as the result of therapy. Varying symptoms
Inflammation mediated by the immune system
What are some things that can trigger asthma?
Exercise, cold air, smoke, food, emotion, menstruation.
Are hospital rates of adult asthma increasing or decreasing?
Increasing
name some risk factors for asthma. Including some that are not proven.
genetic - atopy
occupation
smoking
(maybe - diet, obesity, less exposure to microbes, indoor pollution)
what other disorders are linked with asthma, secondary to the same process of hyper allergic IgE response?
Eczema, food allergy
How much more influential is maternal atopy than paternal atopy?
3x more influential .
How does a mother smoking during pregnancy affects the childs chances of asthma?
will decrease the FEV1 and increase the risk of asthma
Can also modify oocytes
what kind of diet is thought to increase the risk of cancer?
Less vitamins and more oily fish
How do you diagnose asthma?
Make sure there isn’t another cause.
See if it is obstructive, and responds to treatment.
what other things could be mistaken for asthma?
Tumour, foreign body (would give you a lower FEV1)
Generalised airway obstruction - bronchiectasis,, bronchiolitis, cystic fibrosis
what is bronchiectasis?
permanent enlargement of parts of the airway in the lungs
What is bronchiolitis?
inflammation of the bronchioles.
what is the FEV1 / FEV1/FCV predicted to be in asthma?
FEV1 < 80%
FEV1/FVC <70%
However they could be completely normal.
what should we do next is we suspect asthma but the FEV1 / FEV1/FVC is normal?
See if theres any change over 2 weeks.
Then you could do a nitric oxide test - to see levels of nitric oxide in exhaled breath
how does levels of NO in the exhaled breath of people with asthma - differ to the levels in peoples breath without asthma?
Much more in people who asthma
what would a full pulmonary function test exclude?
COPD or emphysema
what drugs does asthma also have an airway responsiveness too?
methacholine and histamine
reversible with B2 agonists or steroids.
How do you test to see if asthma is occupational asthma?
see if the symptoms correspond to being at work (DUH)
make sure you get 2 pairs of exposed / unexposed serial peak flow readings (minimum)
How could a chest X-ray help to diagnose asthma?
to discount any other reasons for the symptoms such as a collapsed lung.
Can asthma cause a pneumothorax?
Yes - so can COPD and other respiratory disorders
How could skin prick testing, IgE tests, and full blood test help diagnose asthma?
atopic testing - eosinophilia in bloods
all associated with asthma
How do you diagnose acute severe asthma?
may not have symptoms
may have no ability to speak, grunting, heart rate, pulse rate, impaired conciseness, hyperventilating
Raised PaCo2
