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Resp. > Asthma > Flashcards

Asthma Flashcards

1
Q

what is asthma characterised by?

A

Asthma is characterised by increased reactivity of the trachea and bronchi to various stimuli, manifested by a widespread narrowing of the airways and bronchial inflammation which may vary IN SEVERITY either spontaneously or with therapy, and typically presents with wheeze and/or cough

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2
Q

what are 4 features of asthma?

A
  • variable/ reversible
  • chronic condition characterised by wheeze
  • responds to treatment
  • various triggers
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3
Q

what are 3 proven risk factors of asthma?

A
  • ->genetic
  • atopy- inherited tendency of IgE response to allergen (maternal atopy most significant)
  • immune response genes (IL-4,IL-5,IgE) or airway genes (ADAM33) in combination with several environmental influences may appear to affect development of asthma
  • ->occupational- enzymes/grains/drugs etc
  • ->smoking - mother during pregnancy / grandmother effect (epigenetic modification of oocytes)
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4
Q

what are other non-proven risk factors of asthma?

A
  • obesity (BMI links)
  • diet
  • reduced microbe exposure
  • abnormal lungs
  • -> multi-hit theory
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5
Q

what are some triggers of asthma?

A

cold air, exercise, perfume, smoke, pets, pollen

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6
Q

what are the main symptoms of asthma?

A
  • wheezing attacks
  • episodic dyspnoea
  • chest tightness
  • cough (paroxysmal/dry)
  • sputum (occasionally)
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7
Q

what is it important to find out with the symptoms of asthma?

A

important to establish evidence of VARIABILITY

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8
Q

when does asthma get worse?

A

in the mornings/late at night

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9
Q

what are 3 signs of asthma?

A
  • breathlessness on exertion
  • polyphonic wheezes
  • HYPEREXPANDED CHEST
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10
Q

what signs indicate that it is probably not asthma?

A
  • clubbing
  • crackles/crepitations
  • dullness on percussion
  • cervical lymphadenopathy
  • stridor -indicates URT obstruction
  • asymmetrical expansion
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11
Q

what do investigations for asthma look for ?

A
  • airway obstruction
  • variability of symptoms
  • reversibility with treatment
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12
Q

what is the flow of events once spirometry is done?

A

if obstruction –> full pulmonary function testing –> check for reversibility with B-2-agonist –> reversibility with steroids
if normal spirometry–> peak flow monitoring –> bronchial provocation & NO

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13
Q

what is spirometry?

A

lung function test which is useful in assessing reversibility

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14
Q

what is FEV1?

A

how much air is expired in first second - proxy for airway diameter

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15
Q

what is FVC?

A

final total amount of air expired- proxy for lung volume

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16
Q

what is the FEV/FVC ratio when airways are obstructed?

A

<70%

17
Q

what is the point of doing a full pulmonary function test once have spirometry results ?

A

to exclude COPD

18
Q

what are the 2 pulmonary function tests done and what do they measure?

A

CO gas transfer - measures HOW EFFICIENT lungs are at exchanging gases
lung volume - measures total size of lung & how air is distributed through them

19
Q

why do you give a beta-2-agonist and what is the expected outcome if asthma?

A

-To assess for reversibility
response:
baseline, 15 mins after 400mcg inhaled Salbutamol
baseline, 15 mins after 2.5mcg nebulised Salbutamol

20
Q

what happens to reversibility outcomes if no bronchoconstriction or if severe bronchoconstriction?

A

no reversibility

21
Q

what do you give after a beta-2-agonist (plus dose) and why?

A

Oral steroids - 0.6MG/KG prednisolone 14 days

  • useful if obstruction but no reversibility/variability
  • differentiates between asthma/COPD
  • aslo give peak flow chart & meter
22
Q

if spirometry is normal, what is the action taken?

A

peak flow meter given to monitor, done twice daily for 2 weeks

23
Q

what is looked for in the peak flow meter readings ?

A
  • any evidence of variability (diurnal, weekly, annually)

- overall variability of >20%

24
Q

what are further specialist investigations which can be done?

A
  • Bronchial provocation–> airway responsiveness to metacholine/histamine
  • Exhaled NO- people with asthma have higher levels of NO in their breath
  • CXR –> checking that there is no effusion, collapse, opacities etc
  • skin prick testing/ total IgE (checking for atopy) - skin prick testing is placing an allergen under the skin and check for wheal and flare reaction
  • FBC (eosinophilia)- atopy
  • Arterial blood gas (P02/PC02)
25
Q

how do you assess acute severe asthma?

A
  • whether patient is able to speak
  • HR- pulse
  • respiratory rate
  • oxygen saturation
26
Q

what is the first step of treatment in asthma

A

oxygen if hypoxic

SABA - salbutamol (MDI/DPI)

27
Q

what is the second step in treatment of asthma & when do you start it

A

ICS- buclamethasone, budesonide, FLUTICASONE
give any dose from 200-800mcg/day, however 400 good starting point.
Start when- on SABA 3 or more times a week, waking up 1 night a week or more, if required steroid for an acute exacerbation any time in past 2 years, if sub-normal exercise tolerance

28
Q

what is the third step in treatment of asthma ?

A

add LABA = formeterol.
if control adequate = continue
if better but control still inadequate= continue LABA but increase ICS to 800mcg/day
if LABA not working = remove LABA and increase ICS to 800mcg/day & consider alternative therapies (leukotriene antagonist/SR theophylline)

29
Q

what is step 4 in treatment of asthma?

A

increase ICS to 2000mcg/day and consider alternative therapies

  • leukotriene receptor antagonist (zafirlukast)
  • theophylline (WEAK bronchodilator & many side effects)
30
Q

what is step 5 in treatment of asthma?

A
  • add DAILY steroid TABLET
  • continue taking ICS at 2000mcg/day
  • refer to specialist
31
Q

what is the treatment regimen in acute (mild/moderate) asthma?

A
  • oral steroids (prednisolone 7 days)

- SABA (every 2 hours)

32
Q

what is the treatment regimen in acute (severe) asthma?

A

hospitalisation, oral/IV steroids, nebulised bronchodilators, antibiotics etc

33
Q

what is the main difference between chronic and acute asthma treatment ?

A 
chronic = inhaled steroids
acute= oral steroids
34
Q

what are the 2 things to always remember about LABA

A
  • never take without ICS

- use FIXED DOSE inhaler

Resp. (9 decks)

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