Asthma Flashcards
What is the definition of asthma?
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
What mediates the airway inflammation?
The immune system
What are the proven risk factors for asthma?
Genetic atopy, occupation and smoking (maternal during pregnancy)
What are the possible risk factors for asthma?
Obesity, diet, reduced exposure to microbes and indoor pollution (household chemicals)
When taking a history what symptoms suggest asthma?
recurrent episodes, wheeze, history of atopy, shortness of breath, chest tightness, chest pain, cough (usually dry) and possibly sputum
What might differentiate asthma from other conditions?
Triggers: exercise, cold air etc.
Daily variation - usually worse at night
Weekly and annual variation
What would you be looking out for in their past medical history?
Childhood asthma, bronchitis, eczema and hayfever
What would you check in relation to medication?
Inhalers (dose and technique)
Other drugs such as beta blockers or aspirin
What would be looking out for in their social history?
Smoking, pets, occupation (past/present) and psychosocial aspects
On examination, which signs would suggest that it is not asthma?
Clubbing, cervical lymphadenopathy, stridor, asymmetrical expansion, dull percussion note or crepitations
If spirometry was normal in someone who you suspected of asthma, what would be your next step?
Give them a peak flow and monitor the variability
How could you exclude COPD from the list of possible diagnoses?
By using lung volume and carbon monoxide gas transfer investigations. Also the response to oral corticosteroids and bronchodilators
What is classed as significant reversibility?
An increase of FEV1 of 15%/200ml or more in response to a bronchodilator
Apart from bronchodilators, what else can be used to test the reversibility of and help diagnose a patients symptoms?
The response to oral corticosteroids such as prednisolone
What optional investigations can a specialist carry out to aid the diagnosis?
Airway responsiveness to methacholine, histamine, mannitol and exercise
Exhaled Nitric Oxide
