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YR6: RESPIRATORY > Asthma > Flashcards

Asthma Flashcards

1
Q

Define Asthma and describe what it is characterised by

A

chronic inflammatory disorder of the airways
Reversible bronchospasm resulting in airway obstruction

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2
Q

List 5 behavioural/ familial risk factors of asthma

A

Personal/ FH of atopy
Antenatal: maternal smoking, infection (esp. RSV)
LBW
Not being breastfed
Maternal smoking around child

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3
Q

List 3 environmental risk factors for asthma

A

Exposure to high conc. allergens e.g. House dust mites
Air pollution
Hygeine hypothesis

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4
Q

What do atopic patients with asthma also suffer from?

A

Other IgE mediated atopic conditions:
Atopic dermatitis (Eczema)
Allergic rhinitis (Hay fever)

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5
Q

What drug are a number of patients with asthma sensitive to?

A

Aspirin

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6
Q

What percentage of adult asthma is occupational asthma? How is this identified?

A

10-15% related to allergens in workplace e.g. isocyanates + flour
Reduced peak flows during working week + normal readings when not at work

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7
Q

List 3 presenting symptoms of asthma

A

Cough (often worse at night)
Dyspnoea
“Wheeze”, “Chest tightness”

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8
Q

Give 2 signs of asthma

A

Expiratory wheeze on auscultation
Reduced peak expiratory flow rate (PEFR)

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9
Q

What spirometry results are seen in asthma?

A

FEV1: significantly reduced
FVC: normal
FEV1/FVC <70%

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10
Q

Which patients with suspected asthma should have objective diagnostic testing?

A

All >5 years

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11
Q

What investigations should adults with suspected asthma have?

A

Spirometry with bronchodilator reversibility test (BDR)
FeNO test

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12
Q

If asthma symptoms are better when away from work, how should the patient be investigated?

A

Serial measurements of PEFR at work + away from work
Refer to specialist as possible occupational asthma

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13
Q

What investigations should children with suspected asthma have?

A
  1. Spirometry with bronchodilator reversibility test (BDR)
  2. FeNO if normal or obstructive spirometry with -ve BDR
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14
Q

What does FeNO testing show?

A

Levels of inducible nitric oxide rise in inflammatory cells (esp. eosinophils) + correlate with levels of inflammation

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15
Q

What FeNO results are considered positive in adults and children?

A

Adults >40 parts per billion
Children >35 parts per billion

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16
Q

What is considered as positive in reversibility testing for asthma in adults and children?

A

Adults: improvement in FEV1 by >,12% + increase in volume of >,200ml
Children: improvement in FEV1 by >,12%

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17
Q

Asthma may be diagnosed in adults meeting any of which 5 criteria?

A
  1. FeNO >,40 ppb
  2. Post-bronchodilator improvement in lung volume of 200 ml
  3. Post-bronchodilator improvement in FEV1 of >,12%
  4. PEFR variability of >,20%
  5. FEV1/FVC ratio <70%
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18
Q

Describe the stepwise management of asthma in adults

A
  1. SABA + Low dose ICS
  2. SABA + Low dose ICS + LTRA
  3. SABA + Low dose ICS + LABA +/- LTRA
  4. SABA +/- LTRA
    Switch ICS/ LABA to MART (inc low dose ICS)
  5. SABA +/- LTRA + medium dose ICS MART
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19
Q

What is an alternative to medium dose ICS MART?

A

Changing back to a fixed dose of a moderate ICS + separate LABA

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20
Q

What management is required for patients with asthma not responding to SABA, LTRA and medium dose ICS MART?

A

Refer to specialist
Increase ICS to high dose (as fixed dose regime, not MART)
Trial additional drug e.g. long acting muscarinic receptor antagonist or Theophylline

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21
Q

What constitutes a low, medium and high dose ICS using budesonide or equivalent?

A

Low: <400 micrograms
Med: 400-800 micrograms
High: >800 micrograms

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22
Q

How often should step down of asthma treatment be considered in stable patients? How would this be done?

A

Every 3 months
Reduce ICS by 25-50% at a time

23
Q

What is the most common chemical cause of occupational asthma?

A

Isocyanates e.g. spray paint + foam moulding using adhesives

24
Q

4 signs of moderate acute asthma exacerbation

A

PEFR 50-75% best/ predicted
Speech normal
RR <25/ min
HR <110 bpm

25
Q

4 signs of severe acute asthma exacerbation

A

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

26
Q

6 signs of life-threatening acute asthma exacerbation

A

PEFR <33% best/ predicted
O2 sats <92%
Normal pCO2 indicates exhaustion
Silent chest, cyanosis, or feeble respiratory effort
Bradycardia, dysrhythmia or hypotension
Exhaustion, confusion or coma

27
Q

What characterises near-fatal asthma exacerbation?

A

Raised pCO2 +/or requiring mechanical ventilation with raised inflation pressures

28
Q

When is an ABG indicated in asthma exacerbations?

A

O2 sats <92%

29
Q

When is a CXR indicated in acute asthma exacerbations?

A

Life-threatening asthma
Suspected pneumothorax
Failure to respond to Tx

30
Q

What are 6 indications for admission of an acute asthma exacerbation?

A

If life-threatening
If severe + fail to respond to initial Tx
If previous near-fatal attack
If pregnant
If attack occurring despite spreading using oral CS
If present at night

31
Q

Which patients should be started on supplemental O2 in acute asthma?

A

If hypoxaemic
If acutely unwell

32
Q

What oxygen therapy should be commenced in an acutely unwell patient?

A

15L via non-rebreathe mask
Titrated down to a flow rate where they can maintain 94-98%

33
Q

Describe management of patients with mild-moderate acute exacerbation of asthma

A

Salbutamol via pressurised MDI, 2-10 puffs every 10-20 mins
40-50mg Prednisolone PO daily for at least 5 days
+/- O2

34
Q

Describe management of patients with severe acute exacerbation of asthma

A

Salbutamol 5mg via oxygen driven nebuliser over 20-30 mins
+
Ipratropium nebs 500 micrograms every 4-6h
+
Prednisolone 40-50mg PO

35
Q

What can be given if severe acute asthma exacerbation is not responsive to initial treatment?

A

Discuss with senior
IV Magnesium Sulfate

36
Q

Describe management of patients with life-threatening acute exacerbation of asthma

A

Salbutamol 5mg via oxygen driven nebuliser over 20-30 mins
+
Ipratropium nebs 500 micrograms every 4-6h
+
Prednisolone 40-50mg PO or Hydrocortisone IV

37
Q

What can be given if life-threatening asthma exacerbation is not responsive to initial treatment?

A

Discuss with senior
IV Magnesium Sulfate
IV Aminophylline
Mechanical ventilation

38
Q

What is the criteria for discharge following admission for acute exacerbation of asthma?

A

Stable on discharge meds (no O2 or news) for 12-24h
Inhaler technique checked + recorded
PEF >75% of best or predicted

39
Q

Describe inhaler technique for metered dose inhalers

A
  1. Remove cap + shake
  2. Breathe out gently
  3. Put mouthpiece in mouth + as you begin to breathe in, which should be slow + deep, press canister down + continue to inhale steadily + deeply
  4. Hold breath for 10s, or as long as is comfortable
  5. For a 2nd dose wait for ~30s before repeating steps 1-4.

Only use the device for the number of doses on the label, then start a new inhaler.

40
Q

What are 5 precipitating factors of asthma?

A 
Cold  
Viral infection  
Drugs (e.g. b-blockers, NSAIDs) 
Exercise  
Emotions
41
Q

What should you ask about when taking history of possible asthma?

A

Previous hospitalisation due to acute attacks- indicates severity of asthma
Hx of atopic disease: allergic rhinitis, urticaria, eczema

42
Q

Why is a normal PCO2 is a BAD SIGN in a patient having an asthma attack?

A

Patient should be hyperventilating + blowing off their CO2, so PCO2 should be low
A normal PCO2 suggests patient is fatiguing

43
Q

Describe the stepwise management of chronic asthma

NICE guidelines

A
  1. SABA (salbutamol)
  2. SABA + ICS
  3. SABA + ICS + LTRA
  4. SABA + ICS + LTRA + LABA
  5. a) + Increase ICS to mod-high dose
  6. b) + slow-release theophylline or Long acting muscarinic receptor antagonist
    • Oral steroids
44
Q

Describe the prognosis of asthma

A

Many children improve when older

Adult onset is chronic.

45
Q

What 3 physiological factors contribute causes difficulty breathing air out of the lungs?

A

Bronchoconstriction
Airway wall thickening
Increased mucus

46
Q

Give an example of each drug used in asthma

A 
SABA: Salbutamol
ICS: Beclometasone, Budesonide
LABA: Formoterol
LTRA: Montelukast
Oral steroid: Prednisolone
47
Q

What is the MOA of SABAs?

A

Relax smooth muscle + dilates bronchioles
“Reliever”, “Blue inhaler”

48
Q

Name 1 side effect of SABAs

49
Q

What is the MOA of ICS?

A

Suppress airway inflammation + reduce airway hyper-responsiveness
Taken every day regardless of Sx
“Preventer”

50
Q

Name 2 side effects of ICS

A

Oral candidiasis
Stunted growth in children

51
Q

MOA of Ipratropium bromide

A

Short acting muscarinic antagonist

52
Q

MOA of LABA and regime?

A

Relax airway smooth muscle
Taken everyday regardless of Sx

53
Q

Which long term asthma medication is taken orally?

A

Monteleukast (LTRA)

54
Q

What measure can be used to assess control of asthma?

A

Asthma Control Test (ACT)

YR6: RESPIRATORY (38 decks)

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