Asthma Flashcards
What does the word mean in greek
Pant heavily or gasp
Characterisation
Increased responsiveness of the trachea and bronchi to stimulus, a widespread narrowing of airways that changes in severity
Symptoms of asthma
Wheezing, coughing, chest tightness, shortness of breath with difficulty in expiration
Gender
More male children but more female adults
Most common chronic disease of childhood in UK
Asthma
Walls of bronchi in asthma
Inflamed and thickened, smooth muscle tightens in an attack
Risk factors for asthma
Genetics,
atopy (IgE- allergic rhinitis, asthma, hay fever and eczema)
First degree family member with it (more maternal)
Smoking, esp during pregnancy and grandmother effect
Occupation
What is most important when making an asthma diagnosis
History
Important parts of history
PMH, drugs, family, social, triggers, variable symptoms
What else could ‘asthma’ be
Airway obstruction (general from COPD, bronchiectasis, cystic fibrosis, or localised from tumour or foreign body, inspiratory stridor) or cardiac
If FEV1 improves with bronchodilator salbutamol
Asthma
If responds to oral corticosteroids (ICS)
Asthma not COPD
If normal spirometry
Look for variability with peak flow twice a day and chart it
Exhaled FeNO
Helpful, higher with asthma
Some useful investigations
IgE, skin prick, full blood count for eosinophils, chest xrays
Moderate asthma attack
Can speak full sentences, HR<110, RR<25, PEF 50-75%, SaO2≥92%, PaO2≥8kPa
Severe asthma attack
Can’t speak a whole sentence, HR≥110, RR≥25, PEF 33-50%, SaO2≥92%, PaO2≥8kPa
Life threatening asthma attack
Grunting, impaired conscious confusion or exhaustion, bradycardia/arrhythmia/hypotension, PEF <33%, cyanosis, silent chest, poor respiratory effort, SaO2<92%, PaO2<8kPa, PaCO2 normal (4.6-6.0kPa)
Near fatal asthma attack
Raised PaCO2 >6.0kPa, need for mechanical ventilation
If quality of life is not affected
Watch and see
How much is genetics
30-80%, 10 variants
Differential diagnosis for asthma under 5 years
Congenital, cystic fibrosis, PCD, bronchitis, foreign body
Differential diagnosis for asthma over 5 years
Dysfunction breathing, vocal cord dysfunction, habitual cough, pertussis
First treatment for asthma
ICS
Second treatment for asthma
LABA
Third treatment (LABA not working)
Stop LABA, try higher ICS
Advantages of inhalers
Small dose, direct delivery to target organ, faster onset, minimal systemic exposure, less systemic adverse effects
SABA
reliever inhalers eg salbutamol, terbutaline (blue)
Oral asthma therapies
Leukotriene receptor agonists, theophylline, prednisolone
Specialist asthma treatments
Omalizumab (anti IgE)
Mepolizumab (anti interleukin -5)
Bronchial thermoplasty
Treatment for moderate/severe asthma attack
Hospital, oral or IV steroids etc
Contrast with COPD
COPD is actual lung damage, but treatment is similar
SANE
S- SABA (reliever) per week
A- absence from school or nursery
N- nocturnal symptoms per week
E- excertional symptoms per week
Dose response for ICS
Logarithmic
Adverse effects of ICS
Height suppression
Inhaled dose with and without a spacer
5% without, 20% with
Dry powder devices
Only under 8s can actually use but 20% deposition in lungs
