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
What very speciliased treatment can be given to a small number of patients with difficult asthma?
- Monoclonal antibody
- anti-IgE injections (omalizumab)
- anti IL-5 treatment (mepolizumab)
- Bronchial thermoplasty
What is a Personal Asthma Action Plan (PAAP)?
A clear plan for patients to see what medication they should be taken and how they should be taking it.
Also explains symptoms they should be looking for in their own asthma and what medication to take
- improves asthma control
- reduces emergency contact with GP
- reduces hospital admissions
What are general features of Acute Severe Asthma?
- Peak expiratory flow rate (PEFR) 33-50% of best (use % predicted if recent best unknown)
- Can’t complete sentences in one breath
- Respirations ≥25 breaths/min
- Pulse ≥110 beats/min
What are life threatening features of Acute Severe Asthma?
- PEFR <33% of best or predicted
- SpO2 (oxygen sat.) <92% (regardless of air or oxygen)
- Silent chest, cyanosis, or feeble respiratory effort
- Arrhythmia or hypotension
- Exhaustion, altered consciousness
What is the management for severe acute asthma?
- Oxygen
- Corticosteroids: prednisolone 40-60mgs orally
- Beta-2 Bronchodilator, through a nebuliser (oxygen driven) - Salbutamol or through a spacer
