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Respiratory > Asthma > Flashcards

Asthma Flashcards

1
Q

Define Asthma

A

Asthma is an obstructive disease caused by chronic inflammation and characterised by recurrent episodes of cough, wheeze and dyspnoea.

Occurs as a result of reversible airway obstruction

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2
Q

What are the signs and symptoms of asthma used in an initial clinical assessment?

A

=> Episodic symptoms - wheeze, cough, breathlessness, chest tightness
=> Dirurnal variability - worse at morning or night
=> Atopic history - Asthma, Eczema, Rhinitis

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3
Q

What signs indicate a severe asthma attack?

A

SEVERE ATTACK

  • Unable to complete sentences in one breath
  • RR ≥ 25/min (so their pH will be low)
  • Pulse ≥ 110bpm
  • PEF 33-50%
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4
Q

What signs indicate a life threatening asthma attack?

A

LIFE THREATENING

  • Exhaustion, coma, confusion
  • Silent chest
  • Arrhythmia or hypotension
  • PEF < 33%

=> In a life threatening attack, they are too exhausted to hyperventilate so their breathing will look normal giving the impression they are fine. They will also be hypoxic

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5
Q

What are the risk factors for an asthma attack?

A
  • Smoking
  • Alcohol
  • Age
  • Obesity
  • Occupational exposure
  • Allergies
  • Gender (Male)
  • Family History
  • Drugs (Aspirin and NSAIDs)
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6
Q

Role of SABA, LABA corticosteroid and leukotriene antagonists in asthma treatment

A

First line treatment is SABA

If not controlled by SABA alone, then add low dose ICS

If still not optimal, add leukotriene antagonist

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7
Q

What is the MOA of ICS and what are its major side affects?

A
  • Reduce mucus hypersecretion
  • Inhibit release of secretagogue from macrophages
  • Interfere with chemotaxis

MAJOR SIDE AFFECTS:

  • Sore throat
  • Cough
  • Oral thrush
  • Nosebleeds
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8
Q

What is MOA of leukotriene antagonists?

A
  • Leukotrienes cause smooth muscle contraction and mucus secretion
  • Inhibiting them decreases these affects
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9
Q

What is MOA of SABA and LABA?

A
  • Activation B2 agonists allow smooth muscle relaxation
  • Via Ca-calmodulin inhibition of MLCK
  • Only difference between SABA and LABA is duration
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10
Q

What are the investigation in suspected asthma?

A

=> PEF monitoring
33-50% in severe asthma
< 33% in life threatening asthma

=> Post bronchodilator FEV1 variability
Improvement in FEV1 by 12% shows asthma or 200ml volume increase

=> FBC
U&E, CRP, blood cultures

=> Spirometry
Obstructive defect so FVC normal and FEV1 lower, therefore decrease if FEV1/FVC

=> CXR

=> FeNO test
In adults, value ≥ 40 parts per billion is positive
In children, value ≥ 35 parts per billion in positive

=> Specialist referral for cases of occupational asthma

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11
Q

What is the EMERGENCY MANAGEMENT of asthma?

A

The severity of the attack is assessed to determine if it is severe or life threatening. Immediate treatment then begins

IMMEDIATE TREATMENT:

  • O2 to maintain stats 94-98%
  • SALBUTAMOL 5mg NEBULISED WITH O2
  • Add IPATROPIUM (LAMA) if severe or life threatening
  • HYDROCORTISONE 100mg IV or PREDINISOLONE 40-50mg PO
  • Reassess after every 15 mins

In reassessment:

  • If PEF < 75%, repeat SALBUTAMOL NEBULISER
  • Monitor ECG
  • consider single dose of MgSO4 1.2-2mg IV in severe cases without improvement after treatment

IF NO IMPROVEMENT - Refer to ICU for more intense treatment. IV SALBUTAMOL if:

  • detoriating PEF
  • persistent worsening hypoxia
  • hypercapnia
  • ABG low pH
  • exhaustion, drowsiness
  • respiratory arrest

IF IMPROVEMENT:

  • Continue nebulised SALBUTAMOL for 4-6 hours
  • PREDINISOLONE 40-50mg PO once a dat for 5-7 days
  • If PEF > 75% after initial treatment, consider discharge
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12
Q

Whats is the management of chronic asthma in children?

A
  1. SABA
  2. SABA + low dose ICS
  3. SABA + low does ICS + leukotriene antagonist
  4. SABA + low does ICS + LABA
  5. SABA + (switch one of the other treatments of 4 with a MART)
  6. SABA + moderate dose MART
  7. SABA + one of the following:
    - ICS high dose
    - trial for additional drug
    - seek advice from HCP
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13
Q

What is the management of chronic asthma in adults?

A
  1. SABA
  2. SABA + low does ICS
  3. SABA + low dose ICS + leukotriene antagonists
  4. SABA + low dose ICS + LABA (continue leukotriene antagonist depending on patients response
  5. SABA +/- LTRA (switch either the ICS or LABA to MART)
  6. SABA +/- LTRA + medium dose MART
  7. SABA +/- LTRA + one of the following:
    - increase ICS to high dose
    - trial additional drug
    - seek advice of HCP
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14
Q

What are the differential diagnosis of asthma?

A
  • Pulmonary oedema
  • Pulmonary Embolism
  • Acute COPD
  • Tension Pneumothorax
  • SVC obstruction
  • Broncheactasis
  • Upper respiratory tract infection
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15
Q

What is the criteria for discharging a patient with asthma?

A

If PEF > 75% within 1 hour of initial treatment, patient can be discharged

Other criteria:

  • Stable on discharge medication for 24h
  • Inhaler technique checked
  • PEF > 75%
  • GP appointment within 2 days
  • Resp clinic appointment within 4 weeks
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16
Q

What is the pathophysiology of asthma?

A

Pathophysiology of asthma involves:

  • Bronchohyperresponsiveness
  • Airflow obstruction
  • Inflammation

The main immune cells involved:

  • Mast cells
  • Eosinophils
  • Dendritic cells
  • IgE
  • T helper cells (Th1 and Th2, Th2 up-regulated in asthma)

Allergens from the lumen are taken up by active dendritic cells in the walls. Thymic stromal lymphocytes act in these dendritic cells, causing them to release chemokines that activate Th2 cells. Th2 cells stimulate plasma cells to release IgE. IgE molecules attach to mast cells. Allergens then bind to IgE-mast cell complex causing degranulation

17
Q

What are the steps taken in escalating acre in those who’s asthma attack is not resolving in emergency management?

A
  1. Oxygen
  2. Salbutamol nebulisers (SABA)
  3. Ipatropium (LAMA)
  4. Hydrocortisone IV or Predinisolone PO
  5. Magnesium Sulfate IV
  6. Aminophylline

Add Leukotriene antagonist before increasing dose of ICS

18
Q

What is the major side affect of ICS

A

Patients on ICS are recommended to wash their mouth after use to prevent the development of oral candidiasis.

19
Q

What is the differential diagnosis for early post-op dyspnoea?

A
  • Atelectasis
  • Pneumonia
  • Pulmonary Embolism
20
Q

What is the appropriate inhaler technique used for asthma?

A
  1. Remove cap and shake
  2. Breathe out gently
  3. Put mouthpiece around mouth, breathe slow and deep, push canister down
  4. Hold breath for 10 seconds, or as long as its comfortable
  5. For second dose, wait for approx 30 seconds

Respiratory (10 decks)

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