Asthma Flashcards
Define Asthma
Type 1 hypersensitivity characterised by reversible inflammation leading to widespread variable bronchoconstriction/obstruction
What is the aetiology of asthma?
FH, especially maternal
Atopic disease
Parental smoking/Grandmother effect
Pollution
What are the triggers of exacerbated asthma?
Allergens: Dust, pollen, animals
Cold weather
Exercise
Infection
Drugs: Aspirin, NSAIDS, B-Blockers
What are the associated conditions with asthma?
Food allergies
Hay fever
Eczema
Describe the presentation of asthma
Non-productive cough
Dyspnoea: Variable and intermittent
Expiratory wheeze: High pitched whistling sound upon expiration
Chest tightness
Worsens at night/nocturnal
Hyperresonance on percussion
Hyperinflated chest
Bronchial breathing: Loud and harsh due to mass/liquid
Reversibility of symptoms
Tachypnoea and tachycardia in attacks
Cyanosis in attacks
What investigations are used in asthma diagnosis and monitoring?
Peak Expiratory Flow Rate (PEFR)
- Best of 3 for 2 weeks
Spirometry with SABA
- Post bronchodilator improvement in FEV1 of 14%Test with Treatment
CXR
- During exacerbations to rule out infection
FBC
- Eosinophils
What is the assessment of an acute exacerbation of asthma?
O2 Stats
RR:
- Moderate: <25
- Severe: >25
Ability to talk in sentences
HR:
- Moderate: <110
- Severe: >110
- Life Threatening: >130
PEFR:
- Normal: 80%
- Restrictive >70%
- Obstructive <70%
Confusion: Hypoxia
ABG: Hypercapnia and Acidosis
What are the signs of severe asthma exacerbation?
PEFR 33-50% predicted
Unable to speak in sentences
Exhaustion/poor respiratory effort
HR > 110
RR > 25
What are the signs of life-threatening asthma exacerbation?
Cyanosis
PEFR: <33% of predicted
O2 SATS: <92%
Can’t speak at all/Silent chest
Confusion
Exhaustion
Hypotension
Describe the management of asthma
Inhaled Short Acting Beta 2 Agonist
- Work quickly but effect only lasts a 1-2 hours
+Inhaled Corticosteroid
+Leukotriene Receptor Antagonist
+ Inhaled Long Acting Beta 2 Agonist
- Work in the same way as SABA but last longer
+ Oral Prednisolone and refer
When should you move up to the next stage of treatment in asthma?
Move up if:
- Waking up once
- Taking SABA twice
- Symptoms 3 times
What are the complications of long term steroid use?
Immunosuppression
Bruising
>Abdominal fat
HTN
Osteoporosis
Diabetes Mellitus
Oral Candidiasis
Avascular necrosis
What is the non-pharmacological management of asthma?
Stop smoking
Check medication compliance
Avoid triggers: Allergens
Encourage exercise to increase lung capacity
Good inhaler technique
Vaccinations
What is the treatment for acute/emergency asthma exacerbations?
O SHIT ME
High flow oxygen
Salbutamol nebulised
IV Hydrocortisone
Nebulised ipratropium bromide
IV Theophylline/aminophylline
IV Magnesium sulphate
Escalate care: Senior support, ICU
Define atrophy
Group of disorders that often run in families mediated by IgE hypersensitivity reaction
