Asthma Flashcards
What causes airflow constriction seen in asthma?
- Bronchoconstriction
- Bronchial secretions and plugs of mucus
- Oedema of the bronchial wall
What is ATOPY ?
- the genetic tendency to develop allergic disease
- tendency to form IgE antibodies to allergens
- often associated with hay fever or eczema in the personal or family history
What are the symptoms of asthma?
- cough
- wheeze
- breathlessness
- chest tightness
occurs in episodes - Diurnal variability; day or night?
What are constriction triggering factors?
- Change in temp.
- Exercise
- strong odours
- cold air
- emotion and stress
What are inflammation triggering factors?
- Respiratory infections
- Allergens
- Work place
What medications can be triggering for Asthma?
- Aspirin
- Ibuprofen
- Beta blockers
What investigations can be done for Asthma?
- Peak flow 2x a day
- spirometry: airflow obstruction may be normal between attacks
- CXR: hyperinflation
- increased eosinophil count
- Fraction exhaled nitric oxide
What are the test lung function results that would indicate Asthma
- FEV1/FVC <70
- PEFR monitoring - 20% diurnal variation
- is it reversible with bronchodilators e.g salbutamol
- 15% and 200mls improvement in FEV1 from baseline
What is FeNO-Fraction of exhaled NO and when is it used?
- measure of airway of eosinophilic inflammation
- performed on patients not on any treatment
- a positive test >40ppb supports a diagnosis of asthma
- can be used to monitor/ look at compliance
What are non-pharmacological treatment of asthma?
- smoking cessation
- weight reduction
- being in less polluted areas
What are long term inhaled pharmacological managements of asthma?
Inhaled corticosteroids
- beclometasone, fluticasone, budesonide, ciclesonide
Inhaled long acting beta 2 agonists (LABA)
- in combination with ICS if its still symptomatic
- never by itself
What are long term oral pharmacological managements of asthma?
- oral leukotriene antagonist-montelukast
- oral theophyllines
in patients with chronicall poorly controlled asthma: low dose of long term oral steroids: prednisolone
What are short term inhaled pharmacological managements of asthma?
Short acting beta agonists (SABA)
- Salbutamol
- Terbutaline
taken as an inhaler 100mcg or nebuliser (high dose 2.5mg, driven by oxygen)
What is Maintenance and Reliever Therapy (MART)?
- LABA formoterol has short onset action
- Equivakent od salbutamal (SABA)
- certain ICS/ LABA combinations can be used as relievers as well as preventers
- this means patients can take additional doses (4/day) for short pperiod (2-3) days to rapidly treay any worsening asthma symptoms
What are DPIs and pMDIs?
Dry power inhalers: activated by inspiration by the patient.–> Powdered drug is dispersed into particles. More mistakes
Pressurised metered dose inhalers: drug dissolved in a propellent (HFCs) under a pressure valve system which releases a metered dose
