Asthma Flashcards
What is the classic presentation of asthma?
Episodic: - wheeze - SOB - chest tightness - cough Diurnal variation Atopic history (personal or family)
What are some triggers for asthma?
exercise infection cold air dust mites pets smoking NSAIDs beta-blockers
What investigations should be done to diagnose asthma?
Spirometry (peak flow) if > 5 years old
Trial of bronchodilator to see if reversible
What is the treatment algorithm for asthma?
SABA only (if infrequent, short lived wheeze - rarely)
+ ICS (start with both if symptoms > 3x week or waking at night)
+ LABA
Increase ICS dose or add LTRA
Refer to specialist
Define moderate acute asthma
PEF > 50-75%
Define severe acute asthma
One of: PEF 33-50% RR > or = 25 HR > or = 110 Inability to complete sentences in one breath
Define life threatening acute asthma
Any one of: PEF < 33% Oxygen sats <92% PaO2 < 8, PaCO2 normal (4.6-6) altered conscious level exhaustion cyanosis hypotension silent chest poor respiratory effort
Which investigation would you do if someone is having an acute asthma attack?
PEF
pulse oximetry
ABGs (if oxygen <92%)
CXR (only if life threatening or suspect pneumothorax or infection)
Which electrolyte imbalance does salbutamol cause?
HYPOkalaemia
What is the treatment for an acute asthma attack?
Oxygen Salbutamol inhaled/nebs Steroids (prednisolone oral, hyprocortisone IV) Ipratropium bromide nebs IV magnesium sulphate
What are the side effects of salbutamol?
Fine tremor
Increased HR and palpitations
Hypokalaemia
Which asthma drug should never be used as mono therapy?
LABAs - salmeterol
–> always with an ICS
Name a LTRA?
Montelukast
Name the methylxanthines?
Theophylline and aminophylline
Side effects of theophylline and aminophylline?
In therapeutic window:
- nausea, vomiting and headaches
In toxicity:
- seizures, arrhythmias, hypokalaemia
