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CP3 @ UoN - Medicine & Surgery > Asthma > Flashcards

Asthma Flashcards

1
Q

Describe Asthma

A

Chronic inflammatory disease characterised by reversible bronchoconstriction and airway hypersensitivity

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2
Q

What are the classical features of Asthma?

A 
Recurrent (reversible) episodes of
-wheeze (widespread, expiratory)
-cough (nocturnal)
-dyspnoea
-chest tightness
Sx worse at night (peak flow worst in morning)
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3
Q

What three factors contribute to airway narrowing?

A

Bronchial muscle contraction
Mucosal swelling/inflammation
Increased mucus production

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4
Q

What are the common symptoms of Asthma?

A

Intermittent dyspnoea, wheeze, cough
Cough often nocturnal
Sputum production

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5
Q

Describe childhood (extrinsic) Asthma

A

Presents early w/ classical symptoms
Type 1 Hypersensitivity reaction
Precipitants often atopic
Can disappear in later life

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6
Q

Describe adult (intrinsic) Asthma

A 
Presents late in life w/ classical symptoms
Non-immune
More severe, quicker deterioration
Precipitants less atopic
-cold
-laughing
-stress
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7
Q

Describe the early phase of an Asthma attack

A

Histamine/Leukotriene/Prost D2 release from mast cell causes contraction of bronchial smooth muscle

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8
Q

Describe the laterphase of an Asthma attack

A

Mucus production from inflammatory cells - repeated attacks damages lining
Airway hyper-reactivity can lead to acute deteriorations

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9
Q

Define chronic Asthma

A

Persistent airway obstruction b/w attacks
Bronchoconstriction & mucosal oedema
A diurnal variation of >20% on >3/7 for 2/52

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10
Q

What are the common precipitants of an Asthma attack?

A 
Cold air
Exercise
Emotion
Allergens - Pet dander, dust, pollen
Viral infection
Smoking
Pollution
Drugs - NSAIDs, B-blockers
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11
Q

What are the clinical features of an acute, severe asthmatic attack?

A 
Tachycardia (>110)
Tachypnoea (>25)
Pulsus paradoxus 
Bilateral widespread expiratory wheeze
Inability to complete sentences
PEF <33-50% predicted
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12
Q

What is Pulsus Paradoxus?

A

An abnormally large drop in systolic BP and pulse wave amplitude during inspiration

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13
Q

What is the immediate investigation required in acute, severe asthma?

A

ABG

CXR only if suspected pneuom/consol OR if patient requires IPPV

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14
Q

What features can suggest a life threatening asthma attack?

A 
Silent chest, cyanosis, poor resp effort
Exhaustion/confusion
Bradycardia, hypotension, dysrhythmia
PEF <33% predicted
SpO2 <90%
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15
Q

What ABG abnormalities would be indicative of severe/life threatening asthma?

A 
Low pH
PaO2 <8.0kPa
PaCO2 4.6-6.0kPa
-PaCO2 can be high in life threatening asthma/chronic attacks
HYPERVENTILATION CAN CONFUSE ISSUES
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16
Q

What is good inhaler technique for MDIs?

A 
Breathe out first
Shake MDI between puffs
Inhale immediately after pressing canister
Hold breath 10 secs
Leave 30-seconds between puffs
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17
Q

What is good inhaler technique for DPIs?

A

Breathe out first
Inhale hard
Hold breath 10 secs

18
Q

What morphological airway changes occur in Asthma?

A 
Fragile epithelial cells (upregulation of EDGF)
Reticular basement membrane thickening
Proliferation of airway SM
Golbet cell/submucosal gland hyperplasia
Oedematous swelling of airway wall
19
Q

What are the key points when taking a history of asthma?

A 
Known precipitants
Diurnal variation in sx
Associated reflux
Atopy hx
Occupation - days off
History of exacerbations - ITU?
20
Q

What is the structure of asthma diagnosis?

A 
Clinical diagnosis
Patients classified as high/low probability of asthma
If high then treat as asthma
-if improves then confirm diagnosis
-if poor response refer for spirometry
21
Q

What spirometry values are diagnostic of asthma?

A

FEV1/FVC <70% w/ bronchodilator reversibility

22
Q

What does the sputum of a chronic asthma pt contain?

A

Charcot-Leyden crystals

Curschman spirals

23
Q

What is the major complication of chronic asthma?

A

Pulmonary HTN

24
Q

What is the management of severe asthma?

A 
O2 - 15L/min via non-rebreather
Salbutamol 5mg via neb (Terb 10mg)
Ipratropium 0.5mg via neb
Oral pred 50mg OR IV hydrocortisone 100mg
NO SEDATIVES
25
Q

What further management is important in life threatening asthma?

A

Discussion w/ ICU team
IV mag sulphate 2g IVI over 20 mins
Salb 5mg neb every 15-30 mins
IV aminophylline/IPPV

26
Q

What medications should be continued once the pt is stable/improving?

A 
Prednisolone OD (>5 days)
Neb Sab/Ipra (4hrly til discharge)
27
Q

What is the aim of long-term asthma management?

A

No daytime sx, no night time waking, no need for rescue medications, no limit on activity

28
Q

What is the first step in asthma management?

A

SABA - Suspected asthma

SABA + Low-dose ICS - Confirmed asthma

29
Q

What is the second step in asthma management?

A

Add LABA (often combined w/ steriod)

30
Q

How should the second step of asthma management be evaluated?

A

If no response from LABA stop it, increase ICS
If some response continue LABA, increase ICS
Consider adding LTRA

31
Q

What is the third step in asthma management?

A

Increase ICS to highest dose
Ensure 4th drug added
Refer to specialist

32
Q

What does specialist management of asthma comprise?

A

Oral B2 agonists
Oral corticosteroids
Anti IgE drugs (Omalizumab)

33
Q

When should you consider raising the level of treatment?

A

If SABA required >3 times/week OR sx are persistent

34
Q

How do B2 agonists work?

A

Relax bronchial smooth muscle

BRONCHODILATORS

35
Q

What are the side-effects of B2 agonists?

A

Tachycardia (B1 in heart)

Tremor, cramps, hypokalaemia (B2 in skm)

36
Q

How long do B2 agonists work for?

A

SABAs - 4-6hrs

LABAs - >12hrs

37
Q

How do ICS work?

A

Reduce exacerbations (anti-inflam)

38
Q

What are the side effects of ICS?

A

Oral candidasis
Pneumonia
Systemic effects of corticosteroid

39
Q

How do LTRAs work?

A

Block effects of leukotrienes in airways

Increase effects of ICS

40
Q

What are the side effects of LTRAs?

A

Thirst
GI disturbance
Churg-Strauss syndrome (systemic vasculitis, v. rare)

41
Q

How do Theophylline/Aminophylline work?

A

Relax smooth muscle

Bronchodilators AND reduce exacerbations

42
Q

What are the side effects of Theophylline/Aminophylline?

A 
Dose-related (sim to caffeine)
Headache
Insomnia
Nausea
Tachycardia
Arrhythmias

CP3 @ UoN - Medicine & Surgery (135 decks)

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