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TCA 2 - Asthma > Asthma > Flashcards

Asthma Flashcards

1
Q

What is asthma?

A

Widespread narrowing of peripheral airways, varying in severity over short periods of time

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2
Q

What is the pathophysiology of asthma?

A
  1. Irritation
  2. Degranulation of mast cells
    - Histamine
    Contraction of smooth muscle, increase blood vessel permeability, increase bronchial secretions, attracts WBCs
    - Chemotactic factors, leukotrienes, prostaglandins and major basic protein released
    Inflammation
  3. Bronchi mucosa swells and smooth muscle contracts
  4. Goblet cells in alveoli secrete mucus in respnse to irritation
    - Narrows lumen
    - Plugs smaller airways
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3
Q

What are the main symptoms of asthma?

A
  • Wheeze
  • Coughing
  • Phlegm
  • Dyspnoea
  • Nasal polyps
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4
Q

What are the risk factors for asthma?

A
  • Recent upper respiratory tract infection
  • Positive family Hx of asthma
  • Allergen exposure
  • Atopic Hx
  • GORD
  • Obesity
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5
Q

What would you look for in a history to diagnose asthma?

A
  • Symptoms
  • Exacerbating factors
  • Family/ Past medical Hx of exacerbating factors
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6
Q

What might you find on examination of a patient with asthma?

A
  • Can be normal
  • Expiratory polyphonic wheeze on chest auscultation
    Has multiple pitches and tones heard over different areas of the lung when the person breathes out
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7
Q

What is the test for airway inflammation?

A

Fractional exhaled nitric oxide (FeNO)

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8
Q

What is a positive FeNO result?

A
  • Adult : ≥ 40 ppb

- Children : ≥ 35 ppb

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9
Q

What can decrease FeNO?

A

Smoking

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10
Q

What are the tests for lung function?

A
  • Spirometry
  • Bronchodilator reversibility (BDR)
  • PEFR
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11
Q

What is a positive spirometry result?

A

FEV1/FVC ratio <70%

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12
Q

What type of airway disease is asthma?

A

Obstructive

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13
Q

What does brochodilator reversibility aim to show?

A

Reversibility of airway obstruction to a short-acting bronchodilator

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14
Q

What is a positive bronchodilator reversibility test result?

A
  • Improvement of FEV1 by ≥ 12%

- Increase in volume of 200ml

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15
Q

What is PEFR?

A

The maximal rate that a person can exhale during a short maximal expiratory effort after full inspiration

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16
Q

How do you predict PEFR?

A

Using a patients sex and height

17
Q

When would you ask a patient to measure PEFR for 2-4 weeks?

A
  • Normal spirometry result
  • Obstructive spirometry result and FeNO ≤ 39 ppb
  • Negative bronchodilator reversibility
18
Q

What is an airway hyperreactivity measure?

A

Direct bronchial challenge test with histamine or methacholine

19
Q

What is a positive direct bronchial challenge test?

A

PC20 value ≤ 8mg/ml

20
Q

When patients present with symptoms for the first time, what other investigations would you order and why?

A
  • CXR
  • FBC

To exclude other differentials

21
Q

What happens if after treatment symptoms control remains poor?

A
  • Step up the treatment ladder
    OR
  • Review diagnosis after 6-10 weeks
    Do not rule out other diagnoses
22
Q

What are asthma triggers?

A
  • Cold weather
  • Dust
  • Allergens - Tree pollen
    Exercise
  • Infections
  • Stress/anxiety
23
Q

What is a reliever inhaler?

A

Blue SABA inhaler

Relieves symptoms when they occur

24
Q

What is a preventer inhaler?

A

Brown inhaled corticosteroid (ICS) inhaler

Used everyday to decrease inflammation and sensitivity of the airways

25
Q

What happens to peak flow after a preventer inhaler is started?

A
  • Peak flow improves
  • Less variation between peaks and troughs on a graph
  • Overall improvement
26
Q

What is the advice given to people with exercise-induced asthma?

A

SABA

  • Used shortly before exercise
  • May be helpful for 2-3 hours
27
Q

How long to LABAs last for?

A

Up to 12 hours

28
Q

What drugs should be avoided in asthma?

A
  • Aspirin
  • NSAIDs
    Ibuprofen
    Naproxen
  • Beta-Blockers
29
Q

How is asthma managed in primary care?

A
  • Individual self-management programme
  • Yearly asthma review
  • Advice on smoking cessation
  • Advice on exercise
30
Q

What questions would you ask in the yearly asthma review as a GP?

A
  1. In the last month/week have you had difficulty sleeping due to your asthma?
  2. Have you had your asthma symptoms during the day?
  3. Has your asthma interfered with your usual daily activities?
31
Q

What vaccinations must asthmatics get?

A
  • Flu vaccine
    Can prevent severe respiratory infections
    Can prevent further inflammation of airways
    Can prevent triggering of asthma attacks
  • Pneumococcal vaccine
    Childhood immunisation now
    People at high risk of infection get 23-valent pneumococcal polysaccharide vaccine
32
Q

How can people with asthma monitor their symptoms?

A

Regular PEFR readings

33
Q

How do you check an inhaler is working?

A
  1. Shake inhaler
  2. Check that the mouthpiece is not obstructed
  3. Squirt twice
34
Q

What does SBAR stand for?

A

SBAR handover

  1. SITATUON
  2. BACKGROUND
  3. ASSESSMENT
  4. RECOMMENDATION
35
Q

What is the atopic triad?

A

Eczema, allergies and asthma

36
Q

What drugs can still be used in pregnancy for asthma?

A

Beta2-adrenergic agonists and inhaled steroids

37
Q

Can prednisolone be used to treat an asthma attack in a pregnant woman?

A

Yes

- Benefit outweighs risk

38
Q

How can anaesthetic potentially trigger an asthma attack?

A
  1. Bronchodilation is controlled by sympathetic innervation (T2-T4)
  2. Anaesthetic blocks the sympathetic NS
39
Q

Is spinal or general anaesthetic safer in a patient with asthma?

A

Spinal

- More localised

TCA 2 - Asthma (8 decks)

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