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BS - Respiratory System > Asthma > Flashcards

Asthma Flashcards

1
Q

What is asthma?

A

a chronic inflammatory disorder of the airways

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2
Q

What 2 effects does asthma have on the airway?

A
  1. airway hyper-responsiveness (of smooth muscle)

2. variable airflow obstruction that is often reversible either spontaneously or with treatment

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3
Q

What are the 4 main risk factors for asthma?

A
  1. Genetic
  2. Maternal atopy
  3. Maternal smoking
  4. Obesity
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4
Q

What is maternal atopy?

A

it occurs when the mother has a tendency to be “hyperallergic”

they often present with 1 or more from eczema, allergic rhinitis or allergic asthma

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5
Q

What are the 2 protection factors from asthma?

A
  1. breast feeding

2. early exposure to animals

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6
Q

What is extrinsic asthma?

A

Extrinsic asthma is triggered by external causes

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7
Q

When does extrinsic asthma usually start?

A

It has a strong family history and starts in childhood

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8
Q

What do people with extrinsic asthma also normally present with?

A

Eczema and/or rhinitis

Skin tests for other allergens are usually positive

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9
Q

How do the symptoms of extrinsic asthma vary?

A

Symptoms are episodic and can be brought on by precipitating factors

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10
Q

When does intrinsic asthma usually begin and what are the precipitating factors?

A

Begins in adulthood

No clear precipitating factors but some sufferers are sensitive to aspirin

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11
Q

Describe the symptoms of intrinsic asthma?

A

Persistent symptoms which are not worsened by external factors

Exacerbated by infections

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12
Q

What do skin tests show in patients with intrinsic asthma?

A

skin tests for other allergens are negative

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13
Q

What is meant by asthma increasing basal tone?

A

Increased smooth muscle contraction which will constrict the airway

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14
Q

How does asthma affect mucous secretion?

A

Hypersecretion of mucous and mucosal oedema

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15
Q

What is mucosal oedema?

A

build-up of fluid within the tissue that lines the body’s interior (mucosa)

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16
Q

What can mucosal oedema lead to?

A

Interstitial oedema where fluid enters the interstitial spaces of the lung

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17
Q

How do symptoms of asthma vary?

A

Tend to be variable, intermittent and provoked by triggers

Symptoms are often worse at night

18
Q

What are the 8 main symptoms of asthma?

A
  1. Polyphonic wheeze
  2. Tachypnoea
  3. Chest tightness
  4. Coughing - particularly at night and early morning
  5. difficulty sleeping
  6. chest pain
  7. vomiting
  8. tremor/hoarse voice
19
Q

Why does asthma cause a hoarse voice?

A

Due to thrush in the mouth which is a side effect of a steroid inhaler

20
Q

Why does asthma cause a tremor?

A

The inhaler contains albuterol

Albuterol is a B agonist that can cause tachycardia

21
Q

How will FEV1/FVC ratio vary in asthma patients?

A

Asthma is obstructive so FEV1/FVC ratio will be reduced

22
Q

How is asthma monitored?

A

Take 2 peak flow readings daily and make a peak flow chart

Peak expiratory flow (PEF) will show >20% diurnal variation on at least 3 days in 2 weeks

23
Q

How do the accessory muscles of respiration change in asthma?

A

They are usually only used during exercise or when particularly out of breath

They are active in asthma patients

24
Q

What is a paradoxical pulse?

A

During inspiration the pulse will fall and it will rise during expiration

paradoxical pulse consists of a large decrease in systolic blood pressure and pulse wave amplitude during inspiration

25
Q

What are the 2 main categories of asthma treatments?

A

relievers and preventers

26
Q

What is the role of the reliever “beta2 adrenoceptor agonist”?

A

stimulates beta2 adrenoceptors in the airway

this leads to relaxation of bronchial smooth muscle

27
Q

What are examples of beta2 adrenoceptor agonists?

A

salbutamol, terbutaline, salmeterol and efomoterol

28
Q

What is the role of antimuscarinic relievers?

A

Inhibit muscarinic receptors on smooth muscle

Leads to relaxation of bronchial smooth muscle

29
Q

What are examples of antimuscarinic relievers?

A

ipratropium bromide and tiotropium

30
Q

What is the role of glucocorticoids as preventers?

A

Bind to cytosolic receptors and affect gene transcription and translation

Leads to potent anti-inflammatory agents and reduced airway hyper-responsiveness

31
Q

What are examples of glucocorticoid preventers?

A

hydrocortisone, prednisolone, beclomethasone, budesonide, flucticasone

32
Q

What are the 4 other treatments used for asthma?

A
  1. leukotriene antagonists
  2. magnesium IV for acute asthma
  3. theophyllines IV
  4. monoclonal antibodies
33
Q

For acute severe asthma, what would PEF, respiration and pulse look like?

A

PEF - 33-50% of best

Can’t complete sentences in one breath

Respiration >/= 25 breaths per min

Pulse >/= 110 beats per min

34
Q

What are the life threatening features of asthma?

What is PEF and SpO2?

A

silent chest, cyanosis or feeble respiratory effort

arrhythmia or hypotension

exhaustion or altered consciousness

PEF < 33% of best

SpO2 < 92%

35
Q

What are the features of near-fatal asthma?

A

Raised PaCO2

Requiring mechanical ventilation with raised inflation pressures

36
Q

When looking at blood gases of an asthmatic, how does pCO2 vary?

A

pCO2 lower than expected in a normal individual

CO2 levels are lower in asthmatics due to increased hyperventilation

37
Q

What is a severe warning sign for severe asthma?

A

Patient is still breathless after being given oxygen

38
Q

What is normal pO2 in arterial and venous blood?

A

arterial - 11-13 kPa

venous - 5 - 5.6 kPa

39
Q

What is normal pCO2 in arterial and venous blood?

A

arterial - 4.7-5.9 kPa

venous - 5.6 - 6.7 kPa

40
Q

What is normal pH in arterial and venous blood?

A

arterial - 7.36 - 7.44

venous - 7.34 - 7.42

41
Q

What steps should be taken to follow up on asthma patients?

A
  1. check compliance with existing therapies
  2. check inhaler technique
  3. education and asthma plan
  4. look for triggers in a new patient and eliminate trigger factors

BS - Respiratory System (20 decks)

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