Asthma Flashcards
what is the prevalence of asthma in the general population?
8%
what are the 3 factors contributing to airway narrowing in asthma?
- bronchial muscle contraction
- mucosal swelling/inflammation
- increased mucus production
what is the process that causes mucosal swelling/inflammation in asthma?
Mast cell and basophil degranulation resulting in the release of inflammatory mediators
What is an extrinsic cause of asthma? Give examples
When a definite cause is found, most common examples are in atopy; triggers include dust, pollen, animals, exercise, smoking, NSAIDS, beta-blockers
What does an intrinsic cause of asthma mean?
There is no external trigger found
Which part of which gene controls IgE synthesis
PHF11 on Ch2
Name 7 symptoms of asthma
Dyspnoea Wheeze Chest tightness Sputum production Nocturnal cough Diurnal variation Disturbed sleep
Name 7 signs of asthma
Tachypnoea Hyperinflated chest Hyper-resonant chest percussion Diminished air entry Prolonged expiration Increased RR
Other than symptoms, what factors indicate diagnosis?
FH, widespread wheeze, improvement with therapy, peripheral eosinophilia, atopy
Which factors make diagnosis less likely?
lack of wheeze, normal chest exam, voice disturbance, symptoms with colds only, significant smoking history + cardiac disease.
What are DDx for asthma?
COPD pulmonary oedema PE Bronchiectasis Foreign object Bronchiolitis Pneumothorax
When should PEFR be taken at home and work?
When an occupational trigger is suspected
Is peak flow more useful for diagnosis or monitoring?
Monitoring
What does spirometry measure?
The presence, severity and reversibility of airway obstruction
How low is an FEV1 to indicate obstruction and reversibility?
(FEV1:FVC=) <0.7
Name 5 possible investigations?
Spirometry Peak flow Skin prick test CXR FBC
What 8 factors define control of asthma?
- no asthma attacks
- no daytime symptoms
- no night time awakening due to asthma
- no exacerbations
- no limitations on activity
- normal lung function
- minimal side effects from medication
What 4 changes in symptoms would each require a step up of treatment?
- using SABA 3 times or more in a week
- symptoms 3+ times a week
- Exacerbation in the last 2 year
- waking up one night a week
Which meds should be avoided in asthma?
NSAIDS, beta blockers
Name the 5 steps of asthma treatment for adults
- start a SABA as required
- Add inhaled cotricosteroid 400 micrograms a day
- Add an inhaled LABA and assess LABA affect- increase dose inhaled corticosteroid if required (800 micrograms)
- consider increasing corticosteroids up to 2,000 a day. Add either leukotriene receptor antagonist. SR theophylline, b agonist tablet
- introduce daily steroid- lowest dose , refer to specialist
Name the 5 steps of asthma treatment for children aged 5-12.
- start a SABA as required
- Add inhaled corticosteroid 200 micrograms
- add laba and reasess- increase corticosteroid to 400 micrograms if required
- increase inhaled corticosteroid to 8000 micrograms per day
- use steroid tablet and refer to respiratory paediatrician
Name the 5 steps of asthma treatment for children aged 0-5.
- start SABA as required
- add inhaled corticosteroid: 200-400 micrograms or a leukotriene agonist if inhaled corticosteroid cannot be used
- add whichever not added in step 2. If under the age of 2, skip to step 4.
- refer to respiratory paediatrician
Name a SABA, LABA, inhaled corticosteroid and oral corticosteroid
salbutamol
salmetrol
beclomethasone dipropronate, budesonide
prednisolone
