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- Y6 Respiratory > Asthma > Flashcards

Asthma Flashcards

1
Q

What is asthma?

A

Chronic inflammatory disorder of intermittent airway obstruction and hyperactivity. Characterised by recurrent episodes of dyspnoea, cough, and wheeze.

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2
Q

What 3 factors contribute to airway narrowing in asthma?

A
  • Bronchial muscle constriction
  • Inflammation (caused by basophil and mast cell degranulation resulting in release of inflammatory mediators)
  • Mucus plugging
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3
Q

What precipitates asthma?

A
  • Cold air
  • Exercise
  • Emotion
  • Allergies (house dust mite, pollen, fur)
  • Infection
  • Smoking and passive smoking
  • Pollution
  • NSAIDs
  • Beta-blockers
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4
Q

What is the diurnal variation seen with asthma?

A

Morning dip in peak flow

(Also a noctunal cough)

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5
Q

What are the risk factors for asthma?

A
  • Personal or FH of atopy
  • Occupational exposure
  • Eczema, atopic dermatitis, allergic rhinitis
  • Cigarette smoking and vaping
  • RSV in early life
  • Nasal polyposis
  • Exposure to high concentrations of allergens (e.g. house dust mite)
  • Air pollution
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6
Q

What should you ask about in a history of an asthma patient?

A
  • Precipitants
  • Diurnal variation
  • Exercise
  • Disrupted sleep
  • Acid reflux - sometimes treating reflux improves spirometry
  • Other atopic disease - eczema, hayfever
  • The home (especially bedroom) - pets, carpet, feather pillows or duvet , other soft furnishings
  • Job - paint sprayers, food processors, welders, animal handlers.
  • Days per week off work or school
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7
Q

What investigations would confirm asthma?

A
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8
Q

What ABG result would signify that an asthmatic needs to be transferred to ITU?

A

Normally the PaCO2 should be low in asthma attack but if it is normal or high then they need to be transferred to ITU for ventilation as this signifies a failing respiratory effort.

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9
Q

How do you manage asthma?

A

BTS guidelines

SABA throughout PRN but if >3 doses/week

  • STEP 1 = Asthma suspected - SABA + consider low-dose ICS
  • STEP 2 = Regular preventer - SABA + low dose ICS
  • STEP 3 = Initial add-on therapy - SABA + low dose ICS + LABA (e.g. salmeterol) (fixed dose or MART)
  • STEP 4 = Additional controller therapies - SABA + medium dose ICS OR LTRA +/- stop LABA if not working
  • STEP 5 = Specialist therapies - refer to specialist
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10
Q

Describe the different severities of acute asthma.

A
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11
Q

What signs are associated with asthma?

A

Tachypnoea

Audible wheeze

Hyperinflated chest

Hyper-resonant percussion note

Decreased air entry

Widespread, polyphonic wheeze

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12
Q

What other differential diagnoses would you consider?

A
  • Pulmonary oedema
  • COPD
  • Large airway obstruction
  • SVC obstruction
  • Pneumothorax
  • PE
  • Bronchiectasis
  • Obliterative bronchiolotis
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13
Q

What are some high risk professions for asthma development?

A
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14
Q

What is the immediate management of acute asthma? What should be considered if the presentation is life-threatening?

A
  • O2 maintain >94%
  • SABA nebs 5mg
  • Ipratropium bromide nebs 0.5mg +/- continue with the SABA nebs every 4-6hrs if effective
  • Prednisolone tablets 40-50mg OD or IV hydrocortisone 100mg 6hrly
  • CXR

If life threatening initially also consider:

  • Seniors
  • SABA NEBS 5mg every 15-30mins
  • +/- Magnesium sulfate 1.2-2g IV over 20mins
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15
Q

If initial acute asthma management does not work after 15-30mins what should be considered?

A
  1. Continuous nebs of SABA at 5-10mg/hr
  2. Continue ipratropium bromide nebs every 4-6hrs
  3. Discuss with ICU
  4. Add IV magnesium sulfate 1.2-2g over 20min
  5. Add IV SABA
  6. OR Add IV aminophylline
  7. Mechanical ventilation
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16
Q

When can you discharge patients after an acute asthma attack?

A
  • PEF >75% of predicted + PEF variability <25%
  • Taking discharge meds for 12-24hrs already, PEF meter given, written action plan
  • Prednisolone 40-50mg 5 days

Follow ups:

  • GP follow up in 2 days
  • Resp clinic follow up in 4 weeks
17
Q

What is the normal PEFR in a 167cm female aged 25yrs?

A

~430 L/min

18
Q

By what time point should SABA nebs be started in ED?

A

By 5mins

Reassess by 15-20mins

19
Q

When should you admit a patient with acute asthma?

A

Life threatening features

Severe asthma features

Previous near fatal asthma

Afternoon or evening attack - have lower threshold for admission

20
Q

What is the usual acute asthma action plan for patients to try at home?

A

10 puffs of salbutamol 4hrly

21
Q

What are the signs and symptoms of life-threatening asthma?

A
  • Exhaustion
  • Hypotension
  • Cyanosis
  • Silent chest
  • Poor respiratory effort
  • Confusion

- Y6 Respiratory (23 decks)

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