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Resp > Asthma > Flashcards

Asthma Flashcards

1
Q

What is asthma

A

Recurrent episodes of dyspnoea, cough and wheeze caused by reversible airway obstruction

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2
Q

Asthma triggers

A 
Cold air + pollution
Exercise
Emotion
Allergens
Infection
NSAIDs + beta blockers
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3
Q

Asthma diurnal variation

A

Peak flow and symptoms vary over day, often worst in mornings

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4
Q

Asthma signs + symptoms

A

Dyspnoea, cough (often nocturnal), wheeze
Hyperinflated chest
Hyper-resonant percussion
Widespread polyphonic wheeze

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5
Q

Asthma history considerations

A

Exercise tolerance
Sleep disturbed for severity assessment
Other atopic disease
Work and home triggers

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6
Q

Asthma severe attack signs

A

Inability to complete sentences
Pulse >110
RR >25
PEF 33-50% predicted

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7
Q

Asthma life threatening attack signs

A 
Silent chest
Confusion, exhaustion
Cyanosis
Bradycardia
Inc PaCO2 if near fatal
PEF<33%
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8
Q

Asthma acute attack tests

A

PEF
Sputum + blood cultures
ABG shows normal/slightly low PaO2 and low PaCO2
If CO2 rising transfer to HDU/ITU as ventilation inadequate

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9
Q

Asthma chronic tests

A

PEF monitoring
Spirometry shows obstructive defect (dec FEV1/FVC, inc RV)
FeNO test if unsure diagnosis, especially in children

CXR shows hyperinflation
Skin-prick may help with allergens

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10
Q

Asthma associated conditions

A

Acid reflux
Polyarteritis nodosa
ABPA
Churg-Strauss vasculitis

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11
Q

Asthma diagnosis + when to refer

A

Spirometry or PEF if spirometry not possible
FEV1/FVC<0.7 trial asthma treatment, if >0.7 refer to treat other cause
If treatment unsuccessful, assess inhaler technique + compliance then refer

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12
Q

Chronic asthma management - lifestyle

A

Quit smoking
Avoid precipitants
Weight to ideal

Inhaler technique
2x daily PEF monitoring
Teach how to use medications and action plan for attack

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13
Q

Chronic asthma management - drugs

A

SABA as needed, if >1/d or night symptoms go down

Add beclometasone 200-400µg/d

Add montelukast

Add LABA (salmeterol 50µg/12h)

Change to maintenance + reliever therapy (LABA+ICS)

Increase ICS dose in MART to 800µg

Add LAMA or theophylline + refer

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14
Q

beta2 agonist MOA

A

Relax bronchial smooth muscle by increasing cAMP

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15
Q

beta2 agonist SE

A 
Tremor
Anxiety
Tachyarrythmias
Hypokalaemia
Paradoxical bronchospasm with LABAs
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16
Q

Corticosteroid MOA in asthma

A

Decrease bronchial mucosal inflammation

17
Q

Aminophylline MOA

A

Metabolised to theophylline which is a PDE inhibitor, dec bronchoconstriction by inc cAMP

18
Q

Aminophylline issues

A

Brand name bioavailability variability so stick with 1 brand
Narrow therapeutic window

Arrythmias
GI upset
Fits

19
Q

Anticholinergics usage

A

Ipratropium, Tiotropium

COPD more than asthma

20
Q

Cromoglicate MOA

A

Mast cell stabiliser

21
Q

Cromoglicate usage

A

Prophylaxis in mild + exercise induced asthma, especially in children

22
Q

Leukotriene receptor antagonist MOA

A

Block cysteinyl leukotriene effects in airways by antagonising CystLT1 receptor

23
Q

Anti-IgE monoclonal Ab usage

A

Omalizumab may be used in persistent allergic asthma, subcut 2-4wks
Prescribed by specialists only

24
Q

Acute severe asthma management

A

Salbutamol 5mg nebulised with O2 + pred 30mg PO
If PEF <75% repeat salbutamol, add ipratropium
Monitor sats, HR, RR, ECG

Consider single 1.2-2g MgSO4 IV over 20 mins for poor responders to initial Rx

25
Q

Acute severe asthma management steps if improving in 15 mins

A

Continue nebulised salbutamol every 4-6h + ipra if started previously

Monitor PEF + sats, aim for 94-98%

If PEF >75% 1h after initial treatment, consider discharge with outpt follow up
Pred 40-50mg/d PO for 5-7d

26
Q

Asthma steroid responsiveness features

A

Previous asthma/atopy hx
Higher blood eosinophil count
>400ml FEV1 variation over time
20% diurnal PEF variation

Resp (18 decks)

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