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Y4 Resp > Asthma > Flashcards

Asthma Flashcards

1
Q

what is the definition of chronic asthma?

A

Episodic, reversible airway obstruction due to bronchial hyper-reactivity to a variety of stimuli.

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2
Q

what is the acute pathophysiology of asthma within the 1st 30mins ?

A

Mast cell-Ag interaction → histamine release

Bronchoconstriction, mucus plugs, mucosal swelling

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3
Q

what is the pathophysiology of chronic asthma within the 1st 12hrs ?

A

TH2 cells release IL-3,4,5 → mast cell, eosinophil and B cell recruitment

Airway remodelling

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4
Q

what are the symptoms of asthma?

A

􏰀 Cough ± sputum (often at night)
􏰀 Wheeze
􏰀 Dyspnoea
􏰀 Diurnal variation ̄c morning dipping

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5
Q

what key 6 questions should be asked during an asthma history?

A 
􏰀 Precipitants
􏰀 Diurnal variation
􏰀 Exercise tolerance
􏰀 Life effects: sleep, work
􏰀 Other atopy: hay fever, eczema
􏰀 Home and job environment
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6
Q

what medications can cause asthma?

A

Drugs: NSAIDS, β-B

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7
Q

how is the wheeze described for asthma?

A

Widespread polyphonic wheeze

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8
Q

what conditions are associated with asthma?

A

ABPA
Churg-Strauss
GORD

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9
Q

what are two DD for asthma?

A

COPD

pulmonary oedema

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10
Q

what blood tests can be done for asthma?

A

FBC (eosinophila)
raised IgE
aspergillus serology

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11
Q

what would CXR show for asthma?

A

hyperinflation

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12
Q

what spirometry pattern show and FEV1:FVC show for asthma?

A

Obstructive pattern ̄c FEV1:FVC < 0.75

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13
Q

by what % does B agonist improve FEV1?

A

> 15%

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14
Q

what general measures can be used for asthma TAME?

A

technique of inhaler use
avoidance of allergens, smoke, dust
monitor peak flow diary
educate with specialist nurse

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15
Q

what is the first step of the asthma ladder?

A

SABA as acquired

short acting b agonist

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16
Q

when does a pt move onto step 2 of the asthma ladder?

A

use more than once a day

nocturnal symptoms

17
Q

what medication is used for step 2 asthma management ?

A

Low-dose inhaled steroid: beclometasone 100-400ug bd

18
Q

what medication is used for step 3 asthma management ?

A

LABA: salmeterol 50ug bd

19
Q

during step 3, what should be done if there is no benefit form the LABA?

A

↑ steroid to 400ug bd

20
Q

what medication is used for step 4 asthma management ?

A

Trials of

􏰀 ↑ inhaled steroid to up to 1000ug bd
􏰀 Leukotriene receptor antagonist
􏰀 SR Theophylline
􏰀 MR β agonist PO

21
Q

what medication is used for step 5 asthma management ?

A

Oral steroids: e.g. prednisolone 5-10mg od

22
Q

what 4 questions should be asked for acute asthma?

A

􏰀 Precipitant: infection, travel, exercise?
􏰀 Usual and recent Rx?
􏰀 Previous attacks and severity: ICU?
􏰀 Best PEFR?

23
Q

what would an ABG for acute asthma show?

A

ABG
􏰁 PaO2 usually normal or slightly ↓
􏰁 PaCO2 ↓

24
Q

would should be done if PaCO2 ↑ on ABG during acute asthma ?

A

send to ITU for ventilation

25
Q

what blood tests can be done for acute asthma?

A

FBC, U+E, CRP , blood cultures

26
Q

what four features indicate severe acute asthma?

A

PEFR <50%
􏰀 RR>25
􏰀 HR >110
􏰀 Can’t complete sentence in one breath

27
Q

what 6 features indicate life threatening acute asthma?

A

PEFR <33%

􏰀 SpO2 <92%, PCO2 >4.6kPa, PaO2 <8kPa

􏰀 Cyanosis

􏰀 Hypotension

􏰀 Exhaustion, confusion

􏰀 Silent chest, poor respiratory effort

􏰀 Tachy-/brady-/arrhythmias

28
Q

what are DD for acute asthma?

A

􏰀 Pneumothorax
􏰀 Acute exacerbation of COPD
􏰀 Pulmonary oedema

29
Q

what are two indications for admission of acute asthma?

A

Life-threatening attack

Feature of severe attack persisting despite initial Rx

30
Q

when should someone with acute asthma be discharged ?

A

􏰀 Been stable on discharge meds for 24h

􏰀 PEFR > 75% ̄c diurnal variability < 20%

31
Q

what is the follow up when someone is discharged with acute asthma?

A

􏰀 PO steroids for 5d
􏰀 GP appointment w/i 1 wk.
􏰀 Resp clinic appointment w/i 1mo

32
Q

what is the initial management of acute asthma?

A

sit up

100% O2 via non rebreathe mark (aim 94-98%)

nebulised salbutamol (5mg) and ipratropium (0.5mg)

hydrocortisone 100mg IV or prednisolone 50mg oral

write no sedation on drug chart

33
Q

what is the management of life threatening acute asthma?

A

inform ITU

magnesium sulphate 2g IVI over 20mins

nebulised salbutomol every 15mins

monitor ECG

34
Q

if a patient with acute asthma is improving, how often should nebulised salbutamol be given?

A

every 4hrs

35
Q

what is the management if someone with acute asthma isn’t improving ?

A

􏰀 Nebulised salbutamol every 15min (monitor ECG)

􏰀 Continue ipratropium 0.5mg 4-6hrly

􏰀 MgSO4 2g IVI over 20min

􏰀 Salbutamol IVI 3-20ug/min

􏰀 Consider aminophylline

  • Load: 5mg/kg IVI over 20min (Unless already on theophylline)
  • Continue: 0.5mg/kg/hr
  • Monitor levels

􏰀 ITU transfer for invasive ventilation

Y4 Resp (17 decks)

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