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Long-term Conditions > Asthma > Flashcards

Asthma Flashcards

1
Q

What is asthma?

A

Chronic respiratory condition of airway inflammation & hyper-responsive

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2
Q

What is the pathophysiology of asthma?

A
  1. environmental trigger causes chemical mediatiors (e.g. histamine) to spill out of eosinophils & destroy cell components
  2. Strong inflammatory reaction in bronchiolar walls
  3. Smooth muscle spasm & increased mucus secretion into narrow airways
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3
Q

Are changes reversible?

A

Initially, yes. But over years, irreversibly changes occur (oedema, scarring, fibrosis). Diameter permanently reduced

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4
Q

What ma be specific triggers of asthma in
Children
Adults

A

Children - laughter + emotion

Adults - Beta blockers + NSAIDs

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5
Q

What is the gold standard for asthma diagnosis?

A

FeNO
Exhaled nitric oxide test. Can determine extent of lung inflammation & how well steroids are suppressing the inflammation

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6
Q

What age can FeNO be used in?

A

> 17 years

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7
Q

What is BDR?

What change should be seen in asthma?

A

Bronchodilator reversibility

FEV1 should improve by 12-15% on second turn. But don’t rule out asthma if results are normal

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8
Q

In adults, what FeNO score is a postitive result?

A

> 40

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9
Q

How do you explain FeNO to a patient?

A

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)

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10
Q

How do you explain spirometry to a patient?

A

You blow into a machine which measures how fast you can breathe out and how much air you can hold in your lungs

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11
Q

What is first line for someone with asthma?

A

SABA

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12
Q

Give 2 examples of SABAs

A

Salbutamol & terbutaline

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13
Q

How long do the effects of SABAs last for?

A 
Rapid onset (within 15 mins)
Last for up to 4 hours
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14
Q

When should an ICS inhaler be added? (3)

A

Using SABA >3 times a week
Asthma symptoms >3 times a week
Woken at night by asthma >once a week

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15
Q

How many times a day should patients use ICS when first started on it?

A

Twice daily

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16
Q

What is added after ICS?

A

LTRA (e.g. monteleukast)

17
Q

How is LTRA delivered & when?

A

Tablet - take at night

18
Q

What is an alternative to adding LTRA? (e.g. if poor adherence of tablet and inhaler)

A

LABA ICS combination

19
Q

What is MART?

A

Maintenance + reliever therapy

ICS + fast-acting LABA used for daily maintenance + symptom relief

20
Q

After trying SABA LABA, LTRA and ICS, what additional drugs can be considered?

A

Theophylline

LAMA (tiotropium)

21
Q

What is PAAP

A

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

22
Q

What is a moderate asthma exacerbation?

A

PEFR >50-70%

Normal speech

23
Q

What is acute severe asthma?

A

PEFR 33-50%

Unable to speak in full sentences

24
Q

What is life-threatening asthma?

Sats

A

PEFR <33%
Sats <92
Altered consciousness, exhaustion, cyanosis, poor resp effort, silence

25
Q

In an asthma attack, how many puffs of SABA should people take before ringing an ambulance?

A

10 puffs (1 min apart)

26
Q

How would you treat an exacerbation?

A

15 L oxygen via a non-rebreathe

Salbulamol nebs on O2 (2.5-5 mg)

Ipratropium 500mcg NEB

IV Hydrocortisone 100mg

27
Q

In exacerbation:

What doses of salbutamol, ipratropium & hydrocortisone are given?

A

2.5-5mg salbutamol

500mcg ipratropium

100mg hydrocortisone

28
Q

If there is no improvement after initial treatment of exacerbation what is the next step?

A

Escalate care (ICU or anaesthetics)

Magnesium sulphate
Theophylline

29
Q

What is an asthma control test?

A

In suspected asthma, trial ICS for 6 weeks

Long-term Conditions (21 decks)

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