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Disease Profile Questions > Asthma > Flashcards

Asthma Flashcards

1
Q

What are the three main characteristics of asthma?

A
  • airflow limitation
  • airway hyper-responsiveness
  • inflammation of the bronchi
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2
Q

what is intrinsic asthma?

A

often starts in middle age, sometimes called late onset asthma. no trigger can be identified

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3
Q

what does atopy mean?

A

term used to describe people who have allergies / asthma / hayfever and where the trait runs in families.

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4
Q

How do you test for airway hyper-responsiveness?

A

bronchial provocation test - ask patient to gradually inhale increasing amounts of methacholine or histamine, this will induce transient airflow limitation in 20% of the population - these patients exhibit airway hyper-responsiveness

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5
Q

what is non-atopic asthma associated with?

A

recurrent respiratory tract infections

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6
Q

what is bronchoconstriction in non-atopic asthma due to?

A

airway hyper-responsiveness

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7
Q

why is aspirin thought to induce asthma?

A

due to increased leukotrienes and decreased prostaglandings, which leads to increased airway irritability

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8
Q

which job professions are susceptible to occupational asthma?

A

bakers, electrician, carpenter, painter, working with polyurethane

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9
Q

which foods can cause asthma attacks?

A

high sodium and low magnesium

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10
Q

what will exposure of antigen in asthma do to CD4 T cells?

A

differentiate into T helper cells (Th2 type) and they will begin to secrete IL-4 and IL-5

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11
Q

what will IL-4 and IL-5 do in asthma?

A

IL-4 will cause B cells to become plasma cells and begin secreting IgE
IL-5 will act on eosinophils and mast cells, making them reactive to the new antigen. other factors are also released which are chemotaxic for eosinophils

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12
Q

what happens to mast cells upon re-exposure?

A

mast cell will be activated and will degranulate. this will release inflammatory markers

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13
Q

what is there an increase in the lungs of asthmatics?

A

number of mast cells in both the airway secretion, and the epithelial lining of lung - therefore increased response to any antigen

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14
Q

what is a asthma attack a result of?

A

histamine and prostaglandin (as well as leukotrienes; particularly LTC4) released by mast cells.

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15
Q

what does histamine do?

A

causes smooth muscle contraction, increased bronchial secretions and increased vascular permeability

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16
Q

what is a late phase reaction of asthma causes by?

A

the accumulation of eosinophils at the site.

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17
Q

what is the effect of cold air and exercise on asthma?

A

both dry out mucosa of the lung, which makes the lining hyperosmolar. this causes mast cells to release histamine and prostaglandins, thus causing inflammation

18
Q

what is the effect of a diet high in fruit and vegetables on asthma?

A

protective, possibly due to large amounts of anti-oxidants

19
Q

what is the ADAM33 gene?

A

thought to be the gene responsible for release of factors by eosinophils. these factors can cause remodelling of the epithelium and stimulate growth of fibroblasts. this increases airway hyper-responsiveness

20
Q

what are the clinical features of asthma?

A
  • wheezing attacks
  • periodic SOB
  • symptoms often worse at night
  • cough is frequent
  • nocturnal cough alone sometimes
  • some patients can have chronic symptoms
21
Q

what two tests are most useful for a diagnosis of asthma?

A

PEFR and Spirometry

22
Q

what other respiratory function tests may be done?

A

carbon monoxide transfer test and NO (levels are raised in breath of asthmatics)

23
Q

what test is used to often diagnose asthma in children?

A

exercise test

24
Q

which test is very useful for children at first presentation?

A

trial of corticosteroids

25
Q

what might a blood and sputum test be used for in asthma?

A

test for eosinophils

26
Q

what would be found on a asthmatic CXR?

A

normal, unless bad exacerbation, in which case, overinflation may be present. good for excluding pneumothorax

27
Q

what should be preformed on all newly diagnosed asthmatics?

A

skin prick test to find cause

28
Q

what is a contra-indication for asthmatics?

A

Beta-blockers

29
Q

What treatment is given for mild intermittent or exercise induced asthma?

A

SABA

30
Q

What is defined as mild intermittent or exercise induced asthma?

A
  • symptoms =2 times a week
  • asymptomatic and normal PERF between attacks
  • attacks are brief with varying intensity
  • night-time symptoms= 2 times a month
  • FEV1 or PERF >/= of predicted
  • PERF variability <20%
31
Q

what treatment is given for mild persistent asthma?

A

low dose inhaled corticosteroid (ISC) added to SABA

32
Q

what second line treatments can be used instead of an ICS?

A

sodium cromoglicate (mostly in children), leukotriene receptor antagonist, nedocromil or theophylline

33
Q

what is mild persistent asthma defined as?

A
  • Symptoms >2 times a week but <1 time a day
  • Exacerbations may affect activity
  • Night-time symptoms >2 times a month
  • FEV1 ≥80% of predicted
  • PEF variability between 20% and 30%.
34
Q

what treatment is given to moderate persistent asthma?

A

add LABA to step 2 therapy or increase low-dose ICS to medium-dose ISC

35
Q

what is moderate persistent asthma defined as?

A
  • Daily symptoms
  • Use of short-acting beta agonists daily
  • Attacks affect activity
  • Exacerbations ≥2 times a week and may last for days
  • Night-time symptoms >1 time a week
  • FEV1 greater than 60% to less than 80% of predicted
  • PEF variability >30%.
36
Q

what is severe asthma defined as?

A
  • Continual symptoms
  • Limited physical activity
  • Frequent exacerbations
  • Frequent night-time symptoms
  • FEV1 ≤60% of predicted
  • PEF variability >60%.
37
Q

what is the treatment for severe asthma?

A

higher dose of ICS. consider leukotriene receptor antagonist or theophyline. consider adding omalizumab

38
Q

what are features of life-threatening asthma?

A
  • silent chest
  • Feeble respiratory effort
  • Cyanosis
  • Exhaustion
  • Bradycardia
  • Hypotenson
  • Exhaustion/confusion/coma
  • PEFR <30% predicted normal or best
39
Q

what are the features of acute severe asthma?

A
  • inability to complete sentences
  • RR >25
  • tachycardia
  • PEFR <50% predicted
40
Q

How do you treat an asthma attack in a emergency situation?

A 
O - oxygen
S - salbutamol (nebulised)
H - hydrocortisone IV
I - ipratropium (nebulised)
T - theophylline
M - magnesium IV
A - anaesthetist (need urgent help)
(n)

Disease Profile Questions (9 decks)

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