Asthma Flashcards
What is asthma?
Chronic respiratory condition of airway inflammation & hyper-responsive
What is the pathophysiology of asthma?
- environmental trigger causes chemical mediatiors (e.g. histamine) to spill out of eosinophils & destroy cell components
- Strong inflammatory reaction in bronchiolar walls
- Smooth muscle spasm & increased mucus secretion into narrow airways
Are changes reversible?
Initially, yes. But over years, irreversibly changes occur (oedema, scarring, fibrosis). Diameter permanently reduced
What ma be specific triggers of asthma in
Children
Adults
Children - laughter + emotion
Adults - Beta blockers + NSAIDs
What is the gold standard for asthma diagnosis?
FeNO
Exhaled nitric oxide test. Can determine extent of lung inflammation & how well steroids are suppressing the inflammation
What age can FeNO be used in?
> 17 years
What is BDR?
What change should be seen in asthma?
Bronchodilator reversibility
FEV1 should improve by 12-15% on second turn. But don’t rule out asthma if results are normal
In adults, what FeNO score is a postitive result?
> 40
How do you explain FeNO to a patient?
You breathe into a machine that measures the levels of nitric oxide in your breath. This can be a sign of inflammation in your lungs)
How do you explain spirometry to a patient?
You blow into a machine which measures how fast you can breathe out and how much air you can hold in your lungs
What is first line for someone with asthma?
SABA
Give 2 examples of SABAs
Salbutamol & terbutaline
How long do the effects of SABAs last for?
Rapid onset (within 15 mins) Last for up to 4 hours
When should an ICS inhaler be added? (3)
Using SABA >3 times a week
Asthma symptoms >3 times a week
Woken at night by asthma >once a week
How many times a day should patients use ICS when first started on it?
Twice daily
What is added after ICS?
LTRA (e.g. monteleukast)
How is LTRA delivered & when?
Tablet - take at night
What is an alternative to adding LTRA? (e.g. if poor adherence of tablet and inhaler)
LABA ICS combination
What is MART?
Maintenance + reliever therapy
ICS + fast-acting LABA used for daily maintenance + symptom relief
After trying SABA LABA, LTRA and ICS, what additional drugs can be considered?
Theophylline
LAMA (tiotropium)
What is PAAP
Personalised asthma action plan
Leaflet patients fill out themselves
Daily asthma routine, how many puffs they normally take, what to do in an attack, their triggers, GP & out of hours contacts etc
What is a moderate asthma exacerbation?
PEFR >50-70%
Normal speech
What is acute severe asthma?
PEFR 33-50%
Unable to speak in full sentences
What is life-threatening asthma?
Sats
PEFR <33%
Sats <92
Altered consciousness, exhaustion, cyanosis, poor resp effort, silence
