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Respiratory > asthma > Flashcards

asthma Flashcards

1
Q

What is asthma characterised by?

A

bronchial hyperresponsiveness

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2
Q

What are the symptoms of asthma

A 
cough
SOB
episodic wheezing
chest tightness
secretions
diurnal variation
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3
Q

What are the two main types of asthma?

A

eosinophilic

non-eosinophilic

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4
Q

What is atopy?

A

tendency to develop IgE

mediated reactions to common aeroallergens

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5
Q

What are the two subtypes of eosinophilic asthma?

A

atopic

non-atopic

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6
Q

What types of allergens/exposures can cause atopic eosinophilic asthma?

A

fungal allergy
common aeroallergens
occupation
pets

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7
Q

What subtypes of non-eosinophilic asthma are there?

A

non-smoking
smoking
obesity related

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8
Q

What are the provoking factors of asthma?

A 
allergens
infections 
menstrual cycle
exercise
cold air
emotion
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9
Q

How can asthma severity be assessed?

A

RCP3 questions (indicates how well controlled the asthma is)

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10
Q

What are the RCP 3 questions?

A

recent nocturnal waking
usual asthma symptoms in a day - wheeze, chest tightness, SOB
interference with ADL

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11
Q

What are the other indicators of asthma severity?

A

no. of inhalers needed
A+E attendances, admissions, HDU, ventilation
attendance at GP for antibiotics and steroids

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12
Q

What should you consider about the asthma in the history?

A

is it asthma
the type of asthma
severity
treatment

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13
Q

What questions should be asked when assessing the history of the complaint?

A

age on onset
features at the onset eg weight loss
childhood ventilation or respiratory disease
obvious causes
PMH - previous pneumonias - bronchiectasis
neurological/renal problems (vasculitis)

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14
Q

What conditions are associated with asthma?

A 
eczema
hayfever
food allergies
drug allergies
reflux disease
nasal disease
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15
Q

What questions should be asked about drugs with asthma?

A

• What are they supposed to be taking?
• What do they actually take?
• Are they taking beta blockers orally or
topically?
• Are they sensitive to NSAIDs or aspirin?
• Drugs with potential interactions:
theophyllines

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16
Q

What questions need to be asked about FH and SH?

A

do they smoke
atopy in the family
pets at home
psychological and psychiatric history

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17
Q

What questions should be asked about their occupation?

A

VDGF exposure

is asthma worse at work/ better on holidays?

18
Q

What are the features of COPD that are different to asthma?

A

later disease of smokers
relentless progressive SOB
less diurnal and day-day variation
winter symptoms with sputum production

19
Q

What can be found on examination in asthma

A

may be normal
wheeze, polyphonic, expiratory and widespread
absence of crackles, sputum, other signs

20
Q

What tests can be done for asthma?

A 
blood count: eosinophils
tests for atopy and allergy: SPTs and 
Radioallergosorbent test (RAST)
CXR useful
oxygen sats
21
Q

What is the FEV1/FVC for obstructive conditions?

A

<70%

22
Q

What are the results of lung functions tests for people with asthma?

A

airways obstruction (reduced FEV1 and FEV1/FVC ratio <70%)
PEFR reductions and variability of 20%
increased responsiveness to challenge by mannitol and methacholine
reversibility testing with bronchodilators or anti-inflammatory

23
Q

What are the tests for airway inflammation?

A

FeNO - exhaled NO

direct measurement of cells - blood eosinophils

24
Q

What are the major definitions for severe asthma?

A

treatment with continuous steroids

or high dose inhaled steroids

25
Q

What are the minor characteristics of severe asthma?

A 
daily reliever medication
persistent airway obstruction (FEV1<80%)
diurnal variation PEFR >20%
≥1 emergency visits p.a.
• ≥3 steroid courses p.a.
• Prompt deterioration with ≤25% reduction in oral or inhaled steroid dose
• Near-fatal event in past
26
Q

Who is most at risk of asthma death?

A

> = 3 classes of treatment
recent admission/ frequent attender
previous near fatal disease
psychosocial factors

27
Q

What are the differential diagnoses of asthma?

A 
Bronchiolitis
• Bronchiectasis*
• CF
• PE
• CEA
• idiopathic pulmonary fibrosis 
• Hyperventilation*
• Bronchial obstruction - foreign body, tumour, etc
• Vocal cord dysfunction*
• Aspiration
• CCF - congestive cardiac failure
• COPD
28
Q

What are the treatments of asthma?

A

avoidance of triggers
bronchodilators
anti-inflammatories
Abs - new biologics

29
Q

What do steroids do?

A

reduce airway inflammation

30
Q

What are the side effects of oral steroids?

A 
diabetes, cataracts, osteoporosis,
hypertension, skin thinning, easy bruising,
growth retardation, osteonecrosis of the
femoral head
hoarse voice
Adrenal suppression
31
Q

What drugs are used for severe eosinophilic asthma?

A

Anti-IgE - Omalizumab
anti-IL-5
oral steroids, additional immunosuppressants

32
Q

What drugs are used for non-eosinophilic asthma?

A

steroid therapy
focus more on bronchodilator treatment
bronchial thermoplasty
(no biological therapies for non-eosinophilic asthma)

33
Q

What should be given to sb immediately when they come with an asthma attack?

A

high flow oxygen

emergency nebulised beta agonist

34
Q

What investigations do you need to recognise a severe attack?

A

PEFR, full clinical assessment
oximetry
CXR if suspect pneumothorax, consolidation and life threatening asthma

35
Q

What measures are used to classify an attack as moderate?

A

PEFR>50% of maximum
RR <25
pulse <110
normal speech

36
Q

What measures would you use to classify an attack as severe?

A 
ANY ONE OF:
PEFR 33-50% of maximum
RR >= 25
HR >=110
inability to complete sentences
37
Q

What measures would you use to classify an attack as life-threatening?

A

PEFR <33%
SaO2 <92% or PaO2 <8 kPa
Normal PaCO2 4.6-6 kPa
altered consciousness level, exhaustion, hypotension, silent chest, poor effort, cyanosis

38
Q

What is used to classify an attack as near fatal?

A

raised PaCO2 and/or requiring ventilation with raised airway pressures

39
Q

What is done to immediately manage an acute asthma attack?

A

oxygen 40-60%
salbutamol nebulised 5mg(+ ipratropium nebulised 0.5mg if life threatening) - repeated IV
prednisolone +/- hydrocortisone
consider magnesium
ABGs
CXR if suspect pneumothorax, consolidation or fails to respond to treatment

40
Q

How can we monitor the response to treatment during an asthma attack?

A

PEFR check within 15-30 mins /regularly
oximetry to maintain SaO2 >92%
repeat ABGs within 2 hours if severe attack or pt is deteriorating
If deteriorating despite maximal treatment with worsening hypoxia,
hypercapnia or coma / exhaustion - ITU transfer
Watch K+, glucose,
Consider rehydration

41
Q

What should be done on discharge?

A

Opportunity to educate and prevent readmissions
• Achieve PEFR > 75% and <25% variability
• Prednisolone for minimum 7-14 days (never
decrease until improving)
• Step up treatment
• Asthma action plan
• Nurse-led follow-up
• Early clinical review (48 hours at GP surgery)
need to be off nebulisers and on stable treatment 24 hours

42
Q

What is the difference between eosinophilic and non-eosinophilic asthma?

A

eosinophilic asthma - Th2 response, IL-5 produced which stimulates the production of eosinophils
B cells produce antigen specific IgE
mast cells degranulate
IL4, 13, 5 involved

non-eosinophilic asthma - Th1 and Th17 response activates monocytes, macrophages , mast cells and neutrophils
the mast ells have complement receptors on them

Respiratory (12 decks)

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