Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 3 - CR > Asthma > Flashcards

Asthma Flashcards

1
Q

What is the definition of asthma

A
  • a combination of cough, wheeze or breathlessness with variable airflow obstruction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what type of disease is asthma

A

Heterogenous disease usually characterised by chronic airway inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what are the 4 symptoms of asthma

A
  • wheeze
  • shortness of breath
  • chest tightness
  • cough
  • with evidence of variable airflow limitation - its reversible
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How many people does asthma affect

A

◦5.4 million people in the UK receive treatment for asthma: 1 in 11 children and 1 in 12 adults
◦Affecting 1 – 18% of the population of different countries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what is a phenotype

A

A phenotype is defined as the set of observable characteristics of an individual resulting from the interaction of its genotype with the environment.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Name the 5 differnet phenotypes of asthma

A 
◦Allergic asthma 
◦Non-allergic asthma
◦Adult-onset (late-onset) asthma 
◦Asthma with persistent airflow limitation
◦Asthma with obesity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Describe allergic asthma

A
  • asthma due to allergies

- has lots of eosinophils

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

describe non allergic asthma

A
  • more neutrophil based
  • do not have an allergen that triggers asthma
  • not responsive to steroids
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Describe adult-onset asthma

A
  • can be due to occupational asthma - working in a bakery or a factor
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

describe asthma with persistent airflow limitation

A
  • due to chronic inflammation that has become irreversible
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what receptors cause bronchodilation

A
  • sympathetic = b2 receptors - these cause bronchodilator and mucocillary clearance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what receptors cause bronchoconstriction

A
  • Parasympathetic = muscarinic receptors and causes bronchoconstriction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What holds the large airways open

A
  • Cartilage holds the large airways open
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How do you work out flow

A

pressure change/resistance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what causes an increase in flow

A
  • increased pressure change

- or decreased resistance (pouseille’s law: resistance 1/r4)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Describe the pathology of asthma

A

Inflammatory process:

  • obstruction
  • airway hyper-responsiveness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Describe what happens in the acute and late phase pathology of asthma

A 
Acute phase:
Mast cells cause 
- bronchospasm 
- oedema 
- mucous

Late phase
TH2 helper cells cause B cells to be produced and this causes IgE and eosinophil production this leads to:
- constriction
- muco-secretion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the extrinsic, intrinsic and occupational causes of asthma

A

Extrinsic

  • air pollution
  • allergen exposure
  • maternal smoking
  • hygiene hypothesis
  • genetics

Intrinsic

  • non allergic
  • less responsive
  • colds/infections

Occupational
- allergens at work

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

how can you diagnose asthma

A
  • no single diagnostic test

- clinical assessment supported by objective evidence of variable airflow obstruction or airway inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the features that make asthma more likely

A

More than one episode of

  • wheeze
  • breathlessness
  • chest tightness
  • cough

Variability
- worse at night and in the O-ring (diurnal variability)

  • trigged by allergen, exercise, cold air, aspirin or beta blocker
  • atomic features
  • family history of asthma/atopy
  • objectively auscultated wheeze on clinical examination
  • low PEFR or FEV
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

why do you produce NO in asthma

A
  • due to high eosinophils which help activate NO producing

- eosinophils use inducible nitric oxide synthetase (iNOS) to produce NO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the differential diagnosis of asthma

A
  • COPD
  • Obstruction due to a foreign body
  • anaphylaxis
  • pulmonary oedema
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the differences between Asthma and COPD

A

Asthma

  • reversible
  • daily FEV1 variation
  • can be related to eosinophils and allergies

COPD

  • older
  • smoking history
  • sputum production
  • not reversible
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what is the treatment difference between asthma and COPD

A

Asthma is chronic inflammation so you use a higher dose of steroids whereas COPD you use lower doses of steroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Name the ways in which you can measure asthma

A
  • spirometry
  • fraction exhaled nitric oxide (FENO)
  • Direct challenge testing (e.g. methacholine)
  • peak flow variability
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What does spirometry measure

A
  • FEV1/FVC
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

what is the diagnostic result of asthma in spirometry

A
  • FEV1/FVC less than 70%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

How can bronchodilators reversibility prove asthma

A
  • FEV1 is measured pre and post beta agonist (salbutamol) inhalation with a spirometry
  • if there is an improvement of 12% or 200ml in FEV1 then it shows that there is asthma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

How can FENO show asthma

A
  • Breath test - marker of eosinophilic inflammation
  • greater than 40ppb
  • multiple confounders
  • 1 in 5 have a false positive/negative
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

How does a direct challenge testing show asthma

A
  • Drop in FEV1 when exposed to provoking substance such as histamine or methacholine
  • concentration required to cause 20% fall in FEV1 (PC20) of 8mg/ml or less
  • low false negative rate
  • 2/3rds with positive test have asthma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

describe how peak flow shows asthma

A
  • twice daily readings over 2 weeks - diurnal variation

- should show 20% variability in PEF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What other tests can be helpful for diagnosing asthma

A
  • IgE
  • allergy/skin prick testing
  • FBC/eosinophil count
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

How do you treat asthma

A
  • avoidance of triggers and allergens

- medical

34
Q

What lifestyle advice should be given for asthma

A
  • Avoid smoking exposure
  • Weight reduction
  • Breathing control exercises may help

• Not recommended:
o House dust mite avoidance
o Air ionisers

35
Q

What do specialists nurses do in the management of asthma (MENTION IN THE OSCE THAT SPECIALIST NURSES DEAL WITH ASTHMA)

A

Asthma nurse review at/shortly after admission improves

  • symptom control
  • self management
  • re-attendance rates
  • Review post discharge within 30 days
36
Q

What does a self management plan of asthma include

A
  • how to use treatment
  • self monitoring/assessment skills
  • action plan with regard to goals
  • recognition and management of exacerbations
  • allergen/trigger avoidance
37
Q

what is the recovery medication for asthma

A
  • short acting B2 agonists - salbutamol
38
Q

What is the mechanism of action of salbutamol

A
  • relax smooth muscle

- receive bronchospasm

39
Q

Give examples of short acting B2 agonists

A
  • Salbutamol

- terbutaline

40
Q

Give examples of long acting B2 agonists

A
  • salmeterol

- formoterol

41
Q

what are the side effects of B2 agonists

A
  • tremor
  • tachycardia
  • sweats
  • agitation
42
Q

What is the mechanism of action of corticosteroids

A
  • decrease inflammation
43
Q

Name examples of corticosteroids for asthma

A
  • budesonide
  • beclometasone
  • fluticasone
44
Q

What are the side effects of corticosteroids in the treatment of asthma

A
  • oral candidiasis - IN OSCE MENTION THEY HAVE TO WASH THERE MOUTH AND THE INHALER AFTERWARDS TO PREVENT THIS
  • systemic side effects rare with inhaled corticosteroids
45
Q

How to leukotriene antagonists work

A
  • block leukotriene receptors in smooth muscle this reduces bronchoconstriction
46
Q

Name an leukotriene antagonists

A
  • Montelukast
47
Q

What are the side effects of leukotriene antagonists

A
  • nausea

- headache

48
Q

what line is luekotreine antagonists in the treatment of asthma

A

2nd line after corticosteroids in NICE guiltiness

3rd in BTS guidelines

49
Q

describe how anti IgE is used as a treatment form asthma

A
  • monoclonal antibody to IgE

- decreases IgE

50
Q

What is an example of anti IgE

A
  • omalizumab - given SC
51
Q

what are the side effects of anti IgE

A
  • itching
  • joint pain
  • headache
  • nausea
  • anaphylaxis
52
Q

What do you need to consider when giving IgE

A
  • confirmed allergic IgE-mediated asthma as an add-on to optimised standard therapy
  • continuous or frequent treatment with oral corticosteroids (defined as 4 or more courses in the previous year)
53
Q

describe the BTS and NICE guidelines for treatment of asthma

A

BTS

  • low dose ICS
  • add inhaled LABA to low dose ICS
  • increase ICS to medium dose or add an LTRA
  • refer patient to specialist care

NICE

  • low dose ICS
  • offer LTRA
  • Add LABA
  • MART then increase ICS in MART or fixed dose ICS/LABA and SABA then LAMA or theophylline
54
Q

describe what should happen with the dosage of corticosteroids

A
  • patients should be maintained at the lowest possible dose of inhaled corticosteroids
  • reduction of about 25-50% each time should be considered every 3 months
55
Q

What is the definition of uncontrolled asthma

A

• 3 or more days a week with symptoms or
• 3 or more days a week with required use of a SABA for symptomatic
relief or
• 1 or more nights a week with awakening due to asthma.

56
Q

How should you assess the risk of future attacks

A

Ask about history of previous attacks, objectively assessing current asthma control, and reviewing reliever use

  • In children, regard comorbid atopic conditions, younger age, obesity, and exposure to environmental tobacco smoke as markers of increased risk of future asthma attacks
  • In adults, regard older age, female gender, reduced lung function, obesity, smoking, and depression as markers of a slightly increased risk of future asthma attacks
57
Q

how does the asthma control test work

A
  • The scores range from 5 (poor control) to 25 (complete control)
  • An ACT score >19 indicates well-controlled asthma.
58
Q

what are the severity levels of asthma

A
  • Near-fatal
  • Life-threatening
  • Acute severe
  • Moderate
  • Brittle
59
Q

what is the difference between type 1 and type 2 brittle asthma

A
  • Type 1: wide PEF variability (>40% diurnal variation for >50% of the time over a period >150 days) despite intense therapy
  • Type 2: sudden severe attacks on a background of apparently well-controlled asthma
60
Q

Describe what moderate asthma looks like

A
  • respiration rate less than 25/min
  • pulse less than 110 bpm
  • PEF greater than 50-75% best or predicted
  • speech normal
  • no features of acute severe asthma
61
Q

Describe what acute severe asthma looks like

A

Any one of:

  • PEF 33-50% best or predicted
  • respiratory rate is greater than 25/min
  • heart rate is 119 bpm or greater than 110 bpm
  • inability to complete sentences in one breath

Admit if persisting symptoms

62
Q

What does life threatening asthma look like

A

Any one of the following in a patient with severe asthma:

  • PEF less than 33% best or predicted
  • SpO2 less than 92%
  • PaO2 less than 8kPa
  • normal PaCO2 (4.6-6kPa)
  • silent chest
  • cyanosis
  • feeble respiratory effort
  • bradycardia
  • dysrhythmia
  • hypotension
  • exhaustion
  • confusion
  • coma
  • call an anaesthetist
  • 33-92 chest (PEF <33%, sats <92%, cyanosis, hypotension, exhaustion, silent chest, tachy or bradycardia)
63
Q

What does near fatal asthma look like

A

Raised PaCO2 and/or requiring mechanical ventilation with raised inflation pressures

64
Q

who do you admit in an asthma attack

A
  • life threatening attack
  • severe attack that does not response to initial treatment

Other admission criteria include
- previous near fatal asthma attack, pregnancy, an attack occurring despite already using oral corticosteroid and presentation at night

65
Q

Who do you discharge after an asthma attack

A

PEF greater than 75% after 1 hour unless

  • significant symptoms
  • compliance concerns
  • lives along
  • psychological/physical/learning problems
  • previous near fatal or brittle asthma
  • pre-existing steroids
  • night time
  • pregnant
66
Q

How do you treat acute asthma

A

ABC

Oxygen

  • aim stats of greater than 92%
  • Oxygen driven nebuliser
  • if acutely unwell = 15L supplemental via a non rebreathe mask

Bronchodilation with short acting beta 2 agonists (SABA)

  • High dose inhaled SABA
  • in patients without life threatening or near fatal asthma this can be given by a standard inhaler or nebuliser
  • if patient has life threatening asthma then nebulised SABA

Corticosteroids
- 40-50mg of prednisolone orally daily which should be continued for at least 5 days or until the patient recovers from the attack

IV fluids

  • rehydration
  • correct electrolyte imabalance

reassess
- every 15 minutes with PEFR

67
Q

What drugs do you give in actue asthma

A

OSHITP

  • Oxygen
  • Salbutamol
  • Hydrocortisone/Prednisolone
  • Ipratropium bromide
  • Theophylline
  • ! Magnesium sulphate
68
Q

How do you give salbutamol in acute asthma

A

Nebulised with oxygen

2.5-5mg every 10 minutes

69
Q

What are the side effects of using salbutamol in an acute asthma attack

A
  • Tremor
  • Arrhythmias
  • Hypokalaemia (monitor ECG)
70
Q

How do you give hydrocortisone in acute asthma

A

IV 100-200mg QDS

Or prednisolone PO 40mg OD

71
Q

How do you give ipratropium bromide

A

Nebulised with oxygen
500 micrograms every 4-6 hours
- given in patients who do not respond to SABA or corticosteroid

72
Q

What are the side effects of nebulised ipratropium bromide

A
  • Arrhythmias
  • cough
  • dizziness
  • dry mouth
  • headache
  • nausea
73
Q

Who and how do you give magnesium sulphate to in an acute asthma

A
  • 1.2 – 2 grams over 20 minutes IV

- Acute severe asthma/ life threatening asthma

74
Q

Who do you give theophylline to and what does it do

A
  • Inhibit phosphodiesterase and increase cAMP – smooth muscle
  • Life-threatening asthma
  • senior guidance
75
Q

What are the side effects of theophylline

A
  • Palpitations (chronotropic effect)
  • Arrhythmias (chronotropic effect)
  • Nausea
  • Seizures (stimulates CNS)
  • Alkali burns if extravasation occurs
  • Drug interactions
76
Q

When do you involve ITU

A
  • All patients requiring ventilatory support
  • Near fatal asthma

Life threatening / acute severe not improving
• Worsening peak flow
• Persistent/worsening hypoxia • High PaCO2
• Low pH
• Exhaustion
• Drowsiness
• Respiratory arrest

77
Q

How do you monitor acute asthma

A
  • regular peak flow
  • oxygen saturations and chest auscultation
ABG 
Repeat at 1 hour if: 
- hypoxic 
- normo-hypercapnoeic 
- patient deteriorates

Bloods

  • potassium
  • glucose

ECG

  • potassium
  • magnesium
  • B2
78
Q

what is the discharge planning after an acute asthma attack

A

Improved symptoms
◦ clinical signs compatible with home management
◦ β2-agonist requirements
◦ therapy can be continued at home

Improved peak flow
◦ >75% best/predicted
◦ <25% diurnal variation

Follow up
o within 48 hrs
o <30 days post discharge by GP/nurse specialist
o under specialist supervision indefinitely for near-fatal asthma and
at least 1 yeat for severe asthma attack

79
Q

Do these OSCE examples

  • Explain to a patient the difference between a reliever and preventer inhaler
  • Demonstrate the use of metered dose inhaler with and without a spacer to a patient
A

Do it

80
Q

What is the differential diagnosis for wheeze

A
  • asthma
  • allergies
  • GORD
  • infection
  • obstructive sleep apnoea
81
Q

How do you diagnose occupational asthma

A
  • PEF taken at home and at work and compared
82
Q

What measures can be taken to prevent and treat occupational lung disease

A
  • avoid the inhaled substances that cause the lung disease

- PPE

Year 3 - CR (44 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions