Asthma Flashcards

1
Q

What is the definition of asthma?

A

A disease characterised by an increased responsiveness of the trachea and bronchi in response various stimuli and manifested by a widespread narrowing of airways which changes in severity either spontaneously or as a result of therapy

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2
Q

What mediates the airway inflammation?

A

The immune system

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3
Q

What are the proven risk factors for asthma?

A

Genetic atopy, occupation and smoking (maternal during pregnancy)

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4
Q

What are the possible risk factors for asthma?

A

Obesity, diet, reduced exposure to microbes and indoor pollution (household chemicals)

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5
Q

When taking a history what symptoms suggest asthma?

A

recurrent episodes, wheeze, history of atopy, shortness of breath, chest tightness, chest pain, cough (usually dry) and possibly sputum

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6
Q

What might differentiate asthma from other conditions?

A

Triggers: exercise, cold air etc.
Daily variation - usually worse at night
Weekly and annual variation

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7
Q

What would you be looking out for in their past medical history?

A

Childhood asthma, bronchitis, eczema and hayfever

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8
Q

What would you check in relation to medication?

A

Inhalers (dose and technique)

Other drugs such as beta blockers or aspirin

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9
Q

What would be looking out for in their social history?

A

Smoking, pets, occupation (past/present) and psychosocial aspects

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10
Q

On examination, which signs would suggest that it is not asthma?

A

Clubbing, cervical lymphadenopathy, stridor, asymmetrical expansion, dull percussion note or crepitations

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11
Q

If spirometry was normal in someone who you suspected of asthma, what would be your next step?

A

Give them a peak flow and monitor the variability

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12
Q

How could you exclude COPD from the list of possible diagnoses?

A

By using lung volume and carbon monoxide gas transfer investigations. Also the response to oral corticosteroids and bronchodilators

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13
Q

What is classed as significant reversibility?

A

An increase of FEV1 of 15%/200ml or more in response to a bronchodilator

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14
Q

Apart from bronchodilators, what else can be used to test the reversibility of and help diagnose a patients symptoms?

A

The response to oral corticosteroids such as prednisolone

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15
Q

What optional investigations can a specialist carry out to aid the diagnosis?

A

Airway responsiveness to methacholine, histamine, mannitol and exercise
Exhaled Nitric Oxide

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16
Q

How is occupational asthma diagnose?

A

Serial peak flow readings, antibodies and bronchial challenge

17
Q

What investigations may be useful in ruling out something else or working out the trigger?

A

Chest X-ray, skin prick testing, total and specific IgE and full blood count (eosinophilia)

18
Q

What signs are used in the assessment of acute severe asthma?

A

Ability to speak, heart rate, respiratory rate, PEF, oxygen saturation and arterial blood gases

19
Q

What are the similarities between children and adults with asthma?

A

Similar symptoms and prevalence. Same triggers, same treatment and same pathology

20
Q

What is the relevance of the reticular basement membrane in children with asthma?

A

It is thicker in children with asthma than in those without

21
Q

In relation to children, which gender is asthma more common in?

A

In children asthma is more common in boys

22
Q

What are the “multiple hits” that cause asthma?

A

Genes, abnormal lungs, atopy and exposure to triggers

23
Q

What is mainly used to diagnose asthma in children?

A

History taking

24
Q

When is it unlikely that a child has asthma?

A

When they only have a cough - likely to be one of many other things

25
Name the features of a moderate asthma attack
- Able to speak complete sentences - HR < 110 - RR < 25 - PEF 50-75% of predicted or best - SaO2 > 92% - PaO2 >8 kPa
26
Name the features of a severe asthma attack
Any one of: - Unable to speak or complete sentences - HR > 110 - RR > 25 - PEF 33-50% predicted or best - SaO2 > 92% - PaO2 > 8 kPa
27
Name the features of a life threatening asthma attack
An one of: - Grunting - Impaired consciousness, confusion and exhaustion - HR > 130 or bradycardic - Hypoventilating - PEF < 33% predicted or best - Cyanosis - SaO2 < 92% - PaO2 < 8 kPa - PaCO2 normal
28
Name the feature that suggests a near fatal asthma attack
Raised PaCo2
29
Which features would make it more likely that child has asthma?
- Wheeze (+/- URTI) - SOB at rest - Parental asthma - Responds to treatment
30
List the differential diagnosis for asthma
- Foreign body - Cystic fibrosis - Immune deficiency - Ciliary dyskinesia - Aspiration - Gastro-oesophageal reflux - Tracheo-bronchomalacia