Asthma Flashcards
What is asthma?
Asthma is a chronic inflammatory disorder of the airways, Chronic inflammation causes an increase in airway hyperresponsiveness that leads to recurrent episodes of wheezing, breathlessness, chest tightness and coughing.
When do the symptoms of asthma tend to be worse?
In the early morning/late night
What is asthma usually mediated by? In terms of its pathophysiology
IgE which is precipitated by an allergic response to an allergen.
What factors are known to contribute to the development of asthma?
Family history of asthma or other atopic conditions Bronchiolitis in childhood Exposure to tobacco smoke premature birth low birth weight occupational exposure to plastics, agricultural substances, and volatile chemicals BMI >30 Bottle feeding
What are the clinical features of asthma?
Wheezing, breathlessness, coughing and chest tightness.
How is a diagnosis of asthma made?
A diagnosis of asthma is based on medical history, physical examination, lung function testing and response to medication.
Spirometry.
What is FVC?
Forced vital capacity (FVC) - the total volume of air expelled by a forced exhalation after a maximal inhalation.
What is FEV1?
Forced expiratory volume in one second - the volume of air expelled in the first second of a forced exhalation after maximal inhalation.
A FEV1/FVC ratio below what is suggestive of airway obstruction?
<0.7
What is peak expiratory flow? when is it used?
Measures the resistance of the airway.
Not as accurate as spirometry, can be used to demonstrate the variability of lung function throughout the day - measurements should be taken in the morning and evening and recorded to see if there is diurnal variability.
Peak flow is better for monitoring patients with an established diagnosis rather than for making an initial diagnosis.
Once control of asthma is achieved, how often should patients be reviewed?
Every 3-6 months (with the aim of moving the patient down to a lower ‘step’)
What are salmeterol and formeterol?
Long acting beta2 agonists (LABAS)
What is monkelukast?
Leukotriene receptor antagonist
What does SIMPLE stand for?
Stop smoking Inhaler technique Monitoring Pharmacotherpy Lifestype Education
What are oxygen targets in asthmatic patients during an acute attack?
94-98%
In asthma, nebulizers should be driven by what?
Oxygen
What is the recommended steroid dose and duration for an acute asthma attack?
Prednisolone 40-50mg daily for at least 5 days
When should ipatropium be used in patients with acute asthma attack?
Use in patients with acute severe or lifethreatening asthma
Remember to stop any LAMAs as this is a SAMA
What is Omalizumab?
Anti IgE - given subcut every 2-4 weeks to patients with high IgE levels in difficult to treat asthma
What drugs could be considered in difficult to treat asthma in order to minimize the amount of oral corticosteroids used?
Ciclosporin, methotrexate, oral gold, terbutlaine
What does tachypnoeic mean?
High respiratory rate
WHat is the normal reference range for respiratory rate?
18-20
Why might patients chest be silent in an asthma attack?
Airways have constricted and so there is no airflow
Why are CO2 levels often low during an acute asthma attack?
Patients are hyperventilating and so ‘blowing off’ CO2
Why might a patient be prescribed IV hydrocortisone during an acute asthma attack?
If patient cannot breath/take oral steroids
What must be carried out in patients admitted to hospital for an asthma attack?
VTE assessment
Upon discharge, what should be given to a patient?
Rescue pack of oral steroids to keep at home.
