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Asthma Flashcards

1
Q

What are the three main characteristics of Asthma?

A
  1. Airflow limitation
  2. Airway hyperresponsiveness
  3. Inflammation of bronchi
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2
Q

Why do you get narrowing of the airways in Asthma?

A
  • Smooth muscle contraction
  • Smooth muscle hypertrophy
  • Mucus hypersecretion
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3
Q

What are the two subsets of eosinophilic asthma?

A
  • Atopic

- Nonatopic

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4
Q

What is atopic asthma?

A
  • Usually present in children and is due to allergies

- IgE mediated reactions to common aeroallergens

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5
Q

What is nonatopic asthma?

A
  • Develops later on and isn’t due to allergen exposure

- Airway obstruction is usually due to exercise, cold air and stress

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6
Q

What is the pathophysiology of atopic asthma?

A
  1. T cells recruit eosinophils which then damage the epithelium
  2. Inflammation = excess mucus production
  3. Narrowing of airways
  4. Remodelling of airway - collagen and matrix proteins
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7
Q

What is non-eosinophilic asthma?

A
  • Has a later onset
  • Affects 50% of patients
  • Neutrophils instead of eosinophils
  • Smoking and obesity association
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8
Q

What are the risk factors for asthma?

A
  • Atopy
  • Nasal polyploidy
  • House dust mites
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9
Q

What is the presentation of asthma?

A
  • Episodic wheeze (polyphonic and expiratory)
  • Cough, SOB
  • Diurnal variation - worse between 3-5am
  • Intermittent dyspnoea
  • Hyperinflated chest
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10
Q

What questions would you ask to assess for asthma?

A
  1. Provoking factors
  2. Severity levels
  3. History of complaint
  4. Associated symptoms
  5. Drugs
  6. Family/social history
  7. Occupational history
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11
Q

What differs COPD from asthma in presentation?

A

COPD presents later and mainly in smokers, more relentless SOB with wheeze, less diurnal variation and sputum production

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12
Q

How does fibrosis differ from asthma in terms of presentation?

A

Presence of crackles in fibrosis

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13
Q

What investigations would you do in asthma?

A
  • Physical examination
  • Tests (CXR, bloods, skin prick)
  • Lung function tests
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14
Q

What would you find on a physical examination in asthma?

A
  • May be normal as asthma is episodic
  • Polyphonic expiratory wheeze
  • No crackles and no sputum
  • Might have a hyper inflated chest
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15
Q

What would you check for on the blood test of an asthmatic?

A

Eosinophils

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16
Q

What would spirometry/peak flow show in asthma?

A
  • Reduced FEV1
  • FEV1/FVC <70%
  • PEFR reduced than expected
  • Increased responsiveness to challenge agents
17
Q

What would you see on an exhaled nitric oxide test in asthma?

A
  • Marker of eosinophils inflammation in lung
18
Q

What would reversibility testing show in asthma?

A
  • Increase in 12% FEV1 and increase of 200ml in FEV = positive test
  • > 400ml increase means asthma is highly likely
  • 20% variability of PEFR also suggests asthma
19
Q

What defines severe asthma?

A

Has to have 1 major and 2 minor of the following:

Major:

  • Treatment with continuous or near continuous oral steroids
  • Requirement for high dose inhaled steroids

Minor:

  • Additional daily reliever medication (beta agonists, theophylline, LTRA),
  • Symptoms needing reliever medication on daily or near daily basis
  • Persistent airway obstruction (FEV1 = 20%)
  • > 1 emergency visit per annum
  • > 3 steroid courses per annum
  • Prompt deterioration with 25% reduction in oral or inhaled steroid dose
  • Near fatal event in the past
20
Q

What would present a risk of death due to asthma?

A
  • > 3 classes of treatment
  • Recent admission/frequent attender
  • Previous near fatal disease
  • Brittle disease
  • Psychosocial factors
21
Q

What for classifications are there for asthma attacks?

A
  • Uncontrolled/moderate
  • Severe
  • Life threatening
  • Near fatal
22
Q

Patient presents with PEFR >50% predicted, RR<25 and HR<110. How would you classify this asthma attack?

A

Uncontrolled/moderate

23
Q

Patient presents with PEFR <33%, PaO2 <8kPa and altered consciousness levels, exhaustion, arrhythmia, hypotension, cyanosis. How would you classify their asthma attack?

A

Life threatening: would only need to have one of those symptoms

24
Q

Patient presents with

  • PEFR 33-50% predicted
  • RR > 25
  • HR >110
  • Inability to complete sentences
A

Severe: Would only need to have one of those symptoms

25
Q

What would a near fatal asthma attack have?

A

Raised PaCO2 and / or requiring ventilation with raised airway pressures

26
Q

What are some non-pharmalogical treatments for asthma?

A
  • Avoidance of triggers
  • Weight loss
  • Record PEF to monitor twice a day
  • Educate about self management
27
Q

I only treat the symptom not the disease. I relax the smooth muscles in the airway and I can be a beta agonist, what class of drugs am i?

A

Bronchodilators

28
Q

What do steroids do in asthma?

A

Recude airway inflammation

29
Q

Give an example of a steroid used in asthma?

A

Beclomethasone

30
Q

How are steroids admitted in asthma?

A

Inhaled steroids and oral have loads of side effects

31
Q

What are the systemic side effects of steroids?

A
  • Diabetes
  • Cataracts
  • Hypertension
  • Skin thinning
  • Easy bruising
32
Q

What are the topical side effects of steroids?

A
  • Horse voice
  • Oral candida
  • Skin thinning
  • Easy bruising
33
Q

Why is important to wean off steroids?

A

They cause adrenal suppression

34
Q

Why would you use biologics for in asthma?

A

In severe eosinophilic asthma

Resp (8 decks)

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