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Respiratory system > Asthma > Flashcards

Asthma Flashcards

1
Q

What is the pathophysiology of asthma?

A

It is type I hypersensitivity reaction, increased irritability and responsiveness of bronchi and trachea to various stimuli, specific IgE and mast cell degranulation causes smooth muscle contraction and inflammation of the aways mediated by immune response and oedema. The result is airway narrowing and blockage.

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2
Q

What type of respiratory condition is asthma?

A

It is obstructive condition with widespread narrowing of the airways.

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3
Q

Which part of respiratory tract is affected?

A

Trachea and bronchi, no alveolar component.

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4
Q

What is characteristic for asthma?

A

It has variable narrowing and therefore severity, it is reversible.

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5
Q

What is the result of increased irritability?

A

Inflammation, increased production of mucus.

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6
Q

What causes narrowing of the airways?

A

It can be spontaneous or with stimuli such as allergen

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7
Q

What immune cells can be found in asthma?

A

Eosinophils and lymphocytes

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8
Q

Describe prevalence in adults and kids

A

More prevalent in kids, more boys, less prevalent in adults more females

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9
Q

What are the proven risk factors ?

A

Genetics -the tendency to IgE response to allergens, occupation and smoking

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10
Q

Describe genetic component of risk factors

A

Inherited tendency of IgE response to allergens, atopy in facility such as hay fever, food allergy, eczema. Mothers have 3times bigger influence than father

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11
Q

Genes associated with genetic component

A

1st group are immune response genes IL4, IL5 IGe and ins group are always gene ADAM33

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12
Q

Describe how smoking increases risk

A

Maternal smoking increases the risk by 1.5 mother and grandmother 2.6due to epigenetic modifications of oocyte

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13
Q

Name the speculative factors

A

Obesity, diet, reduced exposure to microbia, indoor and outdoor solution, environmental pathogens

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14
Q

What is the effect of obesity ?

A

Pro-inflammatory, increased irritability

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15
Q

What is the effect of diet?

A

Reduced antioxidants, n3 polyunsaturated FA, decreased n6 polyunsaturated FA and vitamin D

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16
Q

What are the symptoms of asthma? WTDCS

A

Wheeze, dyspnoea, chest tightness, paroxysmal cough and dry, sputum occasionally

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17
Q

What are some common triggers?

A

Cold air, exercise, perfume, smoke, pets, trees, grass, pollen, food etc

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18
Q

Describe the characteristic variation

A

Worst in early morning, might wake up during the night, weekly variation due to occupation, annual variation due to environmental allergens

19
Q

What are signs of asthma?

A

dyspnoea on exertion, hyperexpanded chest, polyphonic wheeze

20
Q

When it can’t be asthma?

A

If patient has finger clubbing, asymmetrical chest expansion, dull precision note, crepitations, stridor

21
Q

Spirometry test for diagnosis

A

FEV1 less than 80% of expected value and FEV1/FVC ratio less than 70%

22
Q

If spirometry shows obstruction what other tests should be done?

A

Full pulmonary function, CO transfer test, reversibility with beta 2 agonist and oral corticosteroids

23
Q

What should full pulmonary test show?

A

Increased lung volume (bigger residual volume as problems with exhalation, also increased total lung capacity, RV/TLC >30%

24
Q

What should be the result of CO gas transfer test?

A

Shows transfer of CO to Hb across alveoli, it should be normal as asthma has no effect on alveoli, it excludes COPD

25
Q

What is reversibility beta 2 agonist test ?

A

give 400μg inhaled salbutamol, after 15 minutes spirometry or 1.5 -2.5 mg salbutamol after 15 min spirometry, it should show improvement of 200 ml and more than 15%of baseline for FEV1

26
Q

What is reversibility to oral corticosteroids test?

A

Give anti-inflammatory 0.6 mg/kg of prednisolone for 14 days and measure peak flow for 2 weeks

27
Q

What tests should be carried out if no obstruction is detected?

A

Peak flow monitoring, bronchial provocation and exhaled NO

28
Q

Describe peak flow monitoring test

A

Monitor peak flow expiratory rate to show variation and morning dips, variability of 20%

29
Q

What is bronchial provocation test?

A

Measures response to methacholine or histamine, responsiveness to lower doses

30
Q

What does measured NO show?

A

The amount of NO is elevated in asthmatics

31
Q

Other useful tests

A

Chest X ray, skin price test to test for atopy, total and specific IgE, full blood count for eosinophilia

32
Q

How can occupational asthma be diagnosed?

A

By spirometry, 2 hourly measurements for minimum 5 days, improvements on days when not working

33
Q

What are the signs of moderate asthma?

A

Ability to speak in complete sentences, HR<110, RR<25, PEF 50-75% predicted, SaO2 >92%, PaO2>8 kPa

34
Q

What are the signs of severe asthma?

A

Unable to speak , unable to complete sentences, HR>110, RR>25, PEF 33-50%, SaO2>92%, PaO2>8kPa

35
Q

What are the signs of life threatening asthma?

A

Grunting, confusion, impaired consciousness, HR>130, hypoventilation, PEF<33% predicted, SaO2<92%, PaO2<8kPa

36
Q

What is the difference between adult and paediatric asthma?

A

Paediatric asthma is more prevalent in boys, does not tend to persist to adulthood, early onset

37
Q

What are the multiple hits required for asthma?

A

Genetics, inherently abnormal lungs, atopy, exposure

38
Q

What are common differential diagnoses in adults?

A

COPD, bronchiectasis, cystic fibrosis, bronchioloitis

39
Q

What are differential diagnoses for children?

A

Viral induced wheeze, cystic fibrosis, cilliary dyskinesia, tracheo-bronchomalacia (damage to cartilage), aspiration, bronchitis, pertussis

40
Q

What are the relieving inhalers?

A

They are blue, beta 2 agonist or muscarinic antagonists

41
Q

What is the preventative treatment?

A

Corticosteroid ingalers or oral tables, brown inhalers

42
Q

What are the side effects of tea 2 agonists?

A

Palpitations and fine tremor

43
Q

What are the side effects of muscarinic antagonists?

A

blurred vision, dry mouth, nausea, constipation, difficulty urinating, headache

44
Q

What are the side effects of corticosteroids?

A

Thrush, hoarseness or difficulty speaking, sore throat, minor nose bleeds, cough

Respiratory system (22 decks)

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