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Asthma Flashcards

1
Q

Features of moderate asthma exacerbation?

A

Oxygen 92% or above
Peak flow 50% or above
No features of severe attack present

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2
Q

Management of moderate asthma exacerbation?

A

SABA inhaler, 4 puffs initially then 2 puffs every 2 mins to a maximum of 10 puffs

Oral prednisolone

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3
Q

Features of severe asthma exacerbation?

A 
One of:
Peak flow below 33-50%
Tachypnoea (over 25) and cardia (over 110)
Accessory muscle use
Can't speak properly
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4
Q

Management of severe asthma exacerbation?

A 
Oxygen
SABA inhaled 10 puffs or nebulised
Oral prednisolone or IV hydrocortisone
Nebulised ipratropium bromide
Repeat every 20-30 mins
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5
Q

Features of a life-threatening asthma exacerbation?

A 
Any one of:
Oxygen sats less than 92%
Silent chest
Altered consciousness
Poor respiratory effort
Cyanosis
Peak flow below 33%
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6
Q

Management of a life-threatening asthma exacerbation?

A

Oxygen
Nebulised SABA and ipratropium bromide
IV hydrocortisone
IV magnesium sulphate

Consider PICU, where they’ll give IV salbutamol and aminophylline

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7
Q

Long term management of asthma in a child under 5?

A
  1. SABA + ICS
  2. Either leukotriene receptor antagonist OR inhaled corticosteroid 200mcg
  3. Add whichever of the above you haven’t used yet
  4. Refer
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8
Q

Long term management of asthma in a child 5-12 years old?

A
  1. SABA
  2. Add inhaled corticosteroid 200mcg
  3. Add LABA, if not effective increase IC to 400mcg
  4. Increase IC to 800mcg
  5. Add oral prednisolone and refer
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9
Q

Long term management of asthma in a child over 12?

A

As adult management

  1. SABA
  2. Inhaled corticosteroid 400mcg
  3. Add LABA, if not effective increase IC to 800mcg
  4. Add leukotriene, increase IC to 2000mcg
  5. Add oral prednisolone
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10
Q

Long term management of asthma in an adult?

A
  1. SABA
  2. Inhaled corticosteroid 400mcg
  3. Add LABA, if not effective increase IC to 800mcg
  4. Add leukotriene, increase IC to 2000mcg
  5. Add oral prednisolone
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11
Q

Pathophysiology of asthma?

A

Exacerbations triggered by allergen, URTI, cold air, exercise etc.

These trigger inflammation of airways: WBC infiltration, excess mucus, bronchospasm

Airway obstruction leads to symptoms

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12
Q

Presentation of asthma?

A

An acute attack, but sometimes chronic symptoms come out in history

Breathing difficulty, respiratory distress
Cough (at night)
Wheeze
Anxious
Tachypnoea and cardia
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13
Q

What is atopy?

A

Tendency to produce antibodies and have allergic reactions to common environmental antigens (pollen, animal dander, house dust mite faeces)

Hayfever, eczema, asthma

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14
Q

List one or a few of each used in asthma?

  • SABA
  • LABA
  • leukotriene receptor antagonist
  • anti-cholinergic bronchodilator
  • inhaled corticosteroid
  • oral steroid?
A

SABA: salbutamol

LABA: salmeterol, formoterol

Leukotriene: montelukast

Anti-cholinergic bronchodilator: tiotropium

Inhaled corticosteroid: budesonide, beclometasone, fluticasone

Oral steroid: prednisolone

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15
Q

What type of drug is ipratropium bromide? In what cases is it used to treat asthma?

A

It’s an anti-cholinergic bronchodilator

Nebulised and given in severe or life-threatening attacks

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16
Q

How are leukotriene receptor antagonists administered?

A

Orally

17
Q

Which antibody is mostly involved in allergy?

A

IgE

18
Q

When would an asthma attack be considered near fatal?

A

Raised PCO2

Requiring mechanical ventilation

19
Q

6 questions to ask about if asthma is well managed?

A

IN THE LAST 4 WEEKS

  1. difficulty sleeping due to symptoms
  2. usual asthma symptoms during the day
  3. asthma interfering with usual activities
  4. how often do you use inhaler
  5. how often are you SOB
  6. how would you rate asthma control
20
Q

Investigations of asthma?

A

Peak flow

Spirometry reversibility test
Before: FEV1: FVC less than 0.7 (obstructive)
After salbutamol inhaler dose, normal

Allergy test

21
Q

Describe the two types of resp failure?

A

Type 1: 1 thing wrong
Hypoxia, normal CO2
V/Q mismatch: ventilation or perfusion problem

Type 2: 2 things wrong
Hypoxia, hypercapnia
Something stopping lungs inflating properly

22
Q

Why is high flow oxygen bad for some COPD patients?

A

Patient’s who’ve had COPD for years run at high levels of CO2

They lose their hypercapnic respiratory drive

So they rely on hypoxic respiratory drive to keep breathing

By giving oxygen you take away hypoxia, thus taking away their respiratory drive

23
Q

Which non-invasive ventilation would you use for each type of resp failure? Describe how each works (briefly)?

A

CPAP: type 1
Continuous air flow

BiPAP: type 2
Biphasic, so air flows in but stops to allow you to exhale and remove CO2

GP (13 decks)

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