Asthma Flashcards
Not to hate asthma
What are three important questions to ask asthma patients?
In the last month/week have you had DIFFICULTY SLEEPING due to your asthma?
Have you had your usual asthma symptoms DURING THE DAY?
Has your asthma interfered with your usual DAILY ACTIVITIES?
Name 5 conditions in which you can hear wheeze.
Pulmonary Disease COPD Eosinophilic Lung Disease Foreign Body Aspiration Cardiac Failure
What advice should you give re asthma and exercise?
Always have your inhaler on you.
Take an additional dose of the blue inhaler if exercise is known to precipitate asthma.
Try to avoid exercising in the cold/around known allergies.
Why should you advise people with asthma to get the flu jab?
Although people with asthma are not more likely to get the flu, it can be more serious for people with asthma. This is because the have swollen and sensitive airways. The flu can cause further inflammation, triggering asthma attacks and worse asthma symptoms. It can also lead to pneumonia and other acute resp diseases.
What is asthma?
It is a reversible narrowing of the peripheral airways
What other vaccination is recommended in asthma?
Pneumococcal disease
Define PEFR?
Peak Expiratory Flow Rate is the maximal rate that a person can exhale during a short maximal expiratory effort after a full inspiration.
Which measurements do you need to predict peak flow?
Height, age, gender
How long do you record PEFR for diagnosis?
2-4weeks
2x daily
Occupational asthma - 2-4hourly, several weeks
How many doses does a salbutamol inhaler contain?
200
How should you expect patients with asthma to feel if they have well-controlled asthma?
They should go about their lives as normal with no expectation of symptoms
What does dyspnoea mean?
shortness of breath
What is the forced vital capacity? (FVC)
How much air can the patient breath out of their lungs at force. The difference between TLC and Residual Volume
What is FEV1?
The amount of air the patient can forcefully exhale within 1 second. A measure of how wide and strong their airways are
What should the FEV1:FVC ratio be?
80%
How do you measure PEFR from a volume/time graph?
Flow = volume/time so the max slope of FVC curve is equal to the PEFR
What is the TLC?
Equivalent to the amount of air a patient can hold in their lungs
What is the flow/volume loop?
It is a graph that shows the association with flow of air and volume of lungs
What is MVV?
The maximal voluntary ventilation - the amount of air the patient can inhale and exhale within one minute
What is obstructive lung disease?
Lung disease in which the airways are obstructed, for example by a narrowing e.g. in asthma
What is restrictive lung disease?
Diseases that restricts lung expansion
What is COPD?
Chronic obstructive pulmonary disease (COPD) is the name used to describe a number of conditions including emphysema and chronic bronchitis.
What is emphysema
The alveoli/air sacs are enlarged and damaged, reducing the surface area for gas exchange
What is chronic bronchitis?
Chronic inflammation of the lungs, frequently complicated by infections.
What are the FVC, FEV1 and FEV1/FVC ratio values of obstructive lung disease?
FVC: Normal or decreased (severe)
FEV1: Normal or decreased (severe)
FEV1/FVC ration: Decreased <70%
What are the FVC, FEV1 and FEV1/FVC ratio values of restrictive lung disease?
FVC: Normal or decreased (severe)
FEV1: Decreased
FEV1/FVC ration: Normal or Increased >70%
If an FEV1/FVC ratio is low, and the FVC is normal, which kind of lung disease would you suspect?
Obstructive
If an FEV1/FVC ratio is high and the FVC is high, which kind of lung disease do you suspect?
Normal lung mechanics
If the FEV1:FVC ration is high and the FVC is low, which kind of lung disease do you suspect?
Restriction
If you see a flow/volume loop that is ‘shrunk’, which kind of lung disease is that?
Restrictive - the air mechanics is still the same, there just isn’t as much of it.
What are the types of upper airway obstruction?
Extrathoracic - vocal cord paralysis, tracheomalacia, tumour
Intrathoracic - tumour, tracheomalacia
Fixed - tracheal stenosis, goitre, tumour
What are the stages of COPD?
- FEV1 = ≥80%
- 50% ≤ FEV1 <80%
- 30% ≤ FEV1 <50%
- FEV1 <30%
How do you document observations that you suspect could be due to domestic violence?
You record them in the medical notes, noting down facts i.e the exact site and dimensions of the bruising and quote the explanations given by the patient (Body map diagrams can be used if appropriate). Your observations of the patient’s demeanour are part of your examination and so should be documented accordingly.