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Medicine Phase 2a Respiratory > Asthma > Flashcards

Asthma Flashcards

1
Q

2 types

A

Allergic/eosinophilic

Non-Allergic/Non-Eosinophilic

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2
Q

What causes Non-allergic asthma

A

Exercise, cold air, stress

Obesity, Smoking associated

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3
Q

Subtypes of allergic asthma

A

Extrinsic (atopic)

Intrinsic

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4
Q

Describe extrinsic atopic asthma

A

Most frequent

Occurs in atopic individuals and is commonly accompanied by eczema

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5
Q

When does intrinsic asthma start and what usually triggers it

A

Often starts middle-aged and triggered by respiratory infection

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6
Q

Examples of occupational agents (extrinsic cause) that can can non atopic individuals to develop asthma (middle aged)

A

Flour dust and additives in flour
Toluene diisocyanate
Intolerance to NSAIDs (like aspirin)

Block the protective effect of endogenous catecholamines

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7
Q

What is atopy

A

Individuals who rapidly develop IgE against common environmental antigens

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8
Q

Examples of environmental antigens that cause rapid IgE development in atopic individuals

A

House dust mites
Grass pollen
Fungal spores

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9
Q

True or false:

Airway hyper-responsiveness and prevalence of asthma is linked to elevated IgE serum levels

A

True

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10
Q

True or False

Asthma involves just one gene

A

False

Asthma is not one single gene but several genes in combination with environmental factors

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11
Q

Give example of gene associated with asthma

A

ADAM33 - associated with airway hyper-responsiveness and tissue remodelling
Genes controlling production of cytokines IL-3,4,5,9,13

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12
Q

Examples of environmental factors that increase chance of asthma

A

Early childhood exposure to allergens and maternal smoking has a major influence on IgE production
Growing up in a ‘clean’ environment may predispose towards an IgE response to allergens

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13
Q

Risk factors of asthma

A
  • Personal history of atopy
  • Family history of asthma or atopy
  • Obesity
  • Inner-city environment
  • Premature birth
  • Socio-economic deprivation
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14
Q

What is primary abnormality in asthma

A

Narrowing of airway due to smooth muscle contraction, thickening of airway wall by cellular infiltration and pressure of secretions within the airway lumen

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15
Q

Pathophysiology

A 
Copious mucus secretion
Inflammation
Contraction of bronchial muscle
Allergen recognised by Th2 cells
Release of Interleukin (IL)-4, 5, 13
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16
Q

Role of IL-4

A

Stimulates eosinophils and stimulates B lymphocytes
B lymphocytes produce IgE, which causes mast cells to release histamine
Histamine causes bronchoconstriction

17
Q

Role of IL-5

A

Stimulates eosinophils

18
Q

Role of IL-13

A

Stimulates mucus secretion

19
Q

What is asthma

A

Chronic, inflammatory disease that is characterised by reversible airway obstruction

20
Q

Signs and symptoms of asthma

A

Wheezing
Shortness of breath
Coughing
Remember to ask patient for Hx of atopy e.g. hayfever, eczema

21
Q

Triggering factors of asthma

A

Dust/pets/vapours
Emotion
Drugs e.g. beta-blockers

22
Q

Investigations of asthma

A 
Peak expiratory flow rate: note diurnal variation
Sputum sample
ABG (in emergency)
Spirometry (for obstructive defects)
Bloods (increased IgE, FBC)
CXR - pneumothorax, consolidation
23
Q

Conservative treatment

A 
Patient education
Advice on inhaler technique
Avoidance of triggering factors
Annual asthma review
Influenza vaccine required
24
Q

**Medical treatment

British Thoracic Society Guidelines

A

(British Thoracic Society Guidelines)
Step 1: salbutamol/short-acting beta-2 receptor agonist
Step 2: Add Beclometasone (inhaled steroid)
Step 3: Add Salmeterol (long acting beta-2 receptor agonist) + increased total dose of inhaled steroid
Step 4: Add increased dose of inhaled steroid and consider adding additional therapy
Step 5: Instead oral prednisolone (steroid) and high dose inhaled steroid (refer to specialist)

25
Q

Example of Step 4 medical treatment additional therapy

A

Theophylline (xanthine derived bronchodilator that inhibits phosphodiesterase)
Montelukast (leukotriene receptor antagonist)

26
Q

First step of asthma medical treatment

A

salbutamol/short-acting beta-2 receptor antagonist

27
Q

Treatment of acute asthma

A

O SHIT
Oxygen

Salbutamol
Hydrocortisone
Ipratropium
Theophylline

28
Q

Complications

A

Death
Disturbed sleep
Persistent cough

29
Q

Side effects of steroids

A 
Weight gain
Thinning of skin
Striae formation
Cataracts
Cushing's syndrome

Medicine Phase 2a Respiratory (22 decks)

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