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Respiratory Diseases > Asthma > Flashcards

Asthma Flashcards

1
Q

What is asthma?

A

A chronic inflammatory disorder of the airways caused by airway hyper-responsiveness

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2
Q

Give the main physiological abnormalities of asthma

A

Airway hyper-responsiveness
Dynamic hyperinflation (air left in lungs)
Mucus hyper secretion
Mucosal oedema and mucus plugs
Bronchospasm of small and large airways reduces airflow to AND from
Hyper reactive smooth muscle leading to increased basal tone

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3
Q

Is the greatest reduction in airflow for asthma on inhalation or expiration? Why?

A

Expiration

Because the pressure in the chest tends to compress rather than expand the airway

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4
Q

Give 4 prior events that can cause asthma

A 
Prior eczema 
Exercise
Cold
Exposure to allergens e.g. animals
Exposure to irritants e.g. smoke, pollution
Obesity
Maternal smoking
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5
Q

Give two ways asthma can be prevented from developing

A

Breast feeding

Early exposure to animals

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6
Q

What is intrinsic asthma?

A

No family history, evolves in adult hood, persistent symptoms, no clear precipitating factors, negative skin tests, exacerbated by infection

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7
Q

What is extrinsic asthma?

A 
Family history
Starts in childhood
Exczema/rhinitis
Positive skin tests
Episodic
Precipitating factors e.g. allergens
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8
Q

Give some symptoms of asthma

A 
Wheezing
coughing
chest tightness
short of breath
tremor
Cough worst at night
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9
Q

When is the cough/chest tightness often worst and why?

A

At night/early morning because cortisol levels are lowered over night (helps reduce inflammation)

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10
Q

Give some clinical signs of asthma

A 
Wheeze heard
Tachypnoea
Use of accessory muscles for respiration
Paradoxical pulse
Over inflation of chest
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11
Q

Will FEV1 be normal in asthma?

A

No, it will be reduced

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12
Q

Will FEV1/FVC ratio be normal?

A

Will be smaller because smaller FEV1 and normal FVC

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13
Q

What two abnormal test results will come back if someone is asthmatic?

A 
Reduced FEV1 (and so reduced ratio)
Chest X ray showing hyperinflation
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14
Q

Is asthma obstructive or restrictive?

A

Obstructive

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15
Q

Is asthma reversible?

A

yes

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16
Q

How much variation is needed in a peak expiratory flow measure over two weeks for a condition to be reversible?

A

> 20%

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17
Q

What is a useful cough?

A

Expels secretions e.g. in a chest infection

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18
Q

What are the four types of asthma?

A

Asthma associated with allergic reactions
Asthma not associated with a specific allergen
Exercise induced asthma
Asthma associated with COPD due to damage to elasticity of airways

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19
Q

What is increased basal tone?

A

Increased muscle constriction narrowing airways

20
Q

What is the basic mechanism of asthma?

A

Antigen presentation
Antigen presenting cell
B cells produce IgE antibody
This combines with mast cells to activate them
Mast cells release mediators
Mediators act on bronchial muscle causing narrowing of the lumen

21
Q

Why do different types of asthma have to be treated differently?

A

Because no treatment attacks all components of the mechanism (antigen, APC, IgE, mast cells, mediators)

22
Q

What are the pharmacological and non-pharmalogical ways of reducing bronchial hyperactivity?

A

Stop smoking, lose weight

corticosteroids

23
Q

What do acetyl choline and adenosine cause?

A

Bronchoconstriciton

24
Q

What is dynamic hyperinflation?

A

A little of the air of the previous breath remains in the lungs when the next breath is started. This increases the volume of air in the lungs..

25
Q

Is dynamic hyperinflation a feature of asthma?

A

Yes

26
Q

What things caused increased risk of asthma?

A

Genes - 10x higher if first degree relative/maternal atopy
Maternal smoking
Obesity

27
Q

What is FEV1?

A

Functional Expiratory Volume in 1 second - Maximum amount of air that can be expelled forcefully by the lungs in 1 second

28
Q

How does FEV1 change in asthma?

A

Reduced

29
Q

Why is a chest X-ray useful in asthma?

A

To show hyper-expansion of the chest

30
Q

What is FVC?

A

Forced vital capacity - the volume of air that can be exhaled following a deep inhlation

31
Q

How does FVC change in asthma?

A

Remains the same

32
Q

Give some clinical features that differentiate asthma from COPD

A 
Less likely to be a smoker
Symptoms often occur under age 35
Chronic cough uncommon
Periodic/ significant variability
Night time waking common
33
Q

What is a paradoxical pulse?

A

Pulse pressure drops when a breath is taken in due to an increase in stroke volume on inhalation -
Pressure inside the chest cavity falls so air flows in, causing increased venous return to the right heart which compresses the left heart. Lung inflation also compresses left heart. There is therefore a reduced stroke volume.
This is exaggerated in asthma.
(paradoxical = seemingly self-contradicting/absurd)

34
Q

Why does asthma cause a paradoxical pulse?

A

During a severe asthma attack the airways become inflamed and the lungs overinflate. This puts pressure on the veins carrying deoxygenated blood from the heart to the lungs. Blood backs up in right ventricle. This causes compression of the left ventricle. This reduces stroke volume.

35
Q

What do B2 adrenoceptor agonists do?

A

stimulate airway B2 adrenoreceptors which relax bronchial smooth muscle

36
Q

Give an example of a B2 adrenoceptor agonist

A

Salbutamol
Terbutaline
Salmeterol

37
Q

What do antimuscarinics do?

A

Inhibit muscarinic receptors (acetylcholine receptors, which contract muscle) on smooth muscle which relaxes bronchial smooth muscle

38
Q

Give an example of an antimuscarinic?

A 
Ipratopium bromide (atropin)
Tiotropium (spireva)
39
Q

What two types of drug are asthma relievers?

A

B2 adrenoceptor agonists

Antimuscarinics

40
Q

What do glucocorticoids do?

A

Bind to cytosolic receptor to affect gene transcription/translation and cause an anti-inflammatory response that reduces airway hyper repsonsivness

41
Q

Give an example of a glucocorticoid

A

Hydrocotrisone
Prednisolone
Beclomethasone

42
Q

Is salbutamol a long acting or short acting beta-2 agonist?

A

Short acting

43
Q

is Salmeterol a long acting or short acting beta-2 agonist?

A

Long acting

44
Q

Give some examples of preventative medicines

A 
Leukotriene antagonists
Magnesium iv (actue asthma)
Theophyllines
Omalizumab
Glucocorticoids
45
Q

What is the immediate treatment for an acute asthma attack?

A 
Oxygen
Salbutamol 
Ipratropium bromide
Glucocorticoids
No sedatives
Chest X-ray

(magnesium if life threatening)

Respiratory Diseases (10 decks)

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