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RESP - 1 > Asthma > Flashcards

Asthma Flashcards

1
Q

Define asthma

A

Chronic inflammatory disorder of the airways secondary to a type 1 hypersensitivity reaction

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2
Q

When does asthma typically develop?

A

Childhood

Common to grow out of asthma

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3
Q

What is the nature of the symptoms of asthma?

A

Variable, recurring

Manifest as reversible bronchospasm –> airway obstruction

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4
Q

What are risk factors for asthma?

A

Personal/FH of atopy
Antenatal factors - maternal smoking, viral infection during pregnancy (esp RSV)
Low birth weight
Maternal smoking around child
Exposure to high concentrations of allergens, e.g. HDM
Air pollution

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5
Q

What is the hygiene hypothesis?

A

Increased risk of asthma + other allergic conditions in developed countries due to reduced exposure to infections preventing normal development of the immune system

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6
Q

What other atopic conditions are you more likely to suffer from if you have asthma?

A 
Atopic dermatitis (eczema)
Allergic rhinitis (hayfever)
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7
Q

What ENT condition is asthma associated with?

A

Nasal polyps

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8
Q

What medication are a lot of asthma patients sensitive to?

A

Aspirin

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9
Q

What are common examples of occupational allergens?

A

Isocyanates and flour

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10
Q

What is atopy?

A

Inherited tendency to IgE response to allergens (food allergy, hayfever, asthma, eczema)

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11
Q

What are symptoms of asthma?

A

Cough - often worse at night
SoB
Wheeze, chest tightness

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12
Q

What are signs of asthma?

A

Expiratory wheeze on auscultation

Reduced PEFR

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13
Q

What does spirometry measure?

A

Volume and flow of air during inhalation and exhalation

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14
Q

What is spirometry useful for?

A

Distinguishing restrictive from obstructive lung disorders

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15
Q

What are restrictive disorders?

A

Due to restriction to the lungs, e.g. lung fibrosis

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16
Q

What are obstructive disorders due to?

A

Obstruction to airflow

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17
Q

What is FEV1?

A

Forced expiratory volume - volume that has been exhaled at the end of the first second of forced expiration

18
Q

What is FVC?

A

Forced vital capacity - volume that has been exhaled after a maximal expiration following a full inspiration

19
Q

What FVC, FEV1 and FEV1% (FEV1/FVC) are typical of asthma?

A

FEV1 slightly reduced
FVC normal
FEV1% <70%

20
Q

What are common asthma triggers?

A 
Exercise
Cold air
Smoke
Perfume 
URTIs
Pets
Tree/grass pollen
Food
Aspirin
21
Q

What investigations should be done in an adult who is suspected of having asthma?

A

FEV1/FVC ratio
Peak expiratory flow rate
CXR - exclude other pathologies

if spirometry shows FEV1% <70% –> consider full pulmonary function tests, reversibility with beta-agonist and steroids?

If spirometry normal –> PEFR, then consider bronchial provoaction/nitric oxide

22
Q

Why can fractional exhaled nitric oxide be useful to measure in asthma?

A

NO is produced by 3 types of nitric oxide synthases (NOS)
One of these is inducible and levels of it rise in inflammatory cells, esp. eosinophils

SO - levels of NO correlate with levels of inflammation

23
Q

What does the reversibility to bronchodilator test involve?

A

Baseline, 15 min post 400ug inhaled salbutamol/post-neb 2.5-5mg salbutamol
Significant reversibility if change in FEV >200ml or FEV >15% baseline

24
Q

How is reversibility to steroids assessed?

A

Oral corticosteroids

0.6mg/kg prednisolone for 14 days with baseline and 14 day spirometry

25
Q

What is the most common cause of occupational asthma?

A

Isocyanates (common in spray paints/foam moulding)

26
Q

What is the best way to investigate occupational asthma?

A

Serial measurements of PEFR at work and away from work

27
Q

All patients >= 5 years old should have what type of test to confirm a diagnosis of asthma?

A

Objective tests

28
Q

What is involved in the diagnostic testing of asthma of someone who is >=17 years?

A

Are symptoms better when away from work? –> if so refer to specialist on basis it may be occupational asthma

All patients should have spirometry with bronchodilator reversibility test + FeNO test

29
Q

What is involved in the diagnostic testing of asthma of someone who is 5-16 years?

A

All patients should have a spirometry with bronchodilator reversibility test
FeNO test should be req if normal spirometry or obstructive spirometry with negative BDR test

30
Q

What is involved in the diagnostic testing of asthma of someone who is <5 years?

A

Clinical judgement

31
Q

What FeNO level is considered positive in adults?

A

> =40 ppb

32
Q

What FeNO level is considered positive in kids?

A

> = 35 ppb

33
Q

What FEV1/FVC ratio is considered obstructive?

A

<70%

34
Q

What is a positive reversibility test in an adult?

A

FEV1 improvement of 12% or more and increase in vol of 200ml+

35
Q

What is a positive reversibility test in a child?

A

Improvement in FEV1 of 12% or more

36
Q

What is the criteria for moderate acute asthma?

A

PEFR 50-75% best/predicted
Speech normal
RR <25/min
Pulse <100bpm

37
Q

What is the criteria for severe acute asthma?

A

PEFR 33-50% best/predicted
Can’t complete sentences
RR >25/min
Pulse >110bpm

38
Q

What is the criteria for life-threatening acute asthma?

A 
PEFR <33% best/predicted
O2 sats <92%
Silent chest, cyanosis or feeble resp effort
Bradycardia, dysrhythmia or hypotension
Exhaustion, confusion or coma
Normal pCO2 indicates exhausation
39
Q

What is the criteria for severe acute asthma in a child?

A 
SpO2 < 92%
PEF 33-50% best or predicted
Too breathless to talk or feed
Heart rate
    >125 (>5 years)
    >140 (1-5 years)
Respiratory rate
    >30 breaths/min (>5 years)
    >40 (1-5 years)
Use of accessory neck muscles
40
Q

What is the criteria for life threatening acute asthma in a child?

A 
SpO2 <92%
PEF <33% best or predicted
Silent chest
Poor respiratory effort
Agitation
Altered consciousness
Cyanosis

RESP - 1 (27 decks)

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