Asthma Flashcards
What is asthma?
Asthma is a chronic inflammatory disease of the airways. Bronchoconstriction occurs where the smooth muscles of bronchi contract, this causes narrowing of the airways causing an obstruction to airflow. Can be triggered by environmental stimuli.
What are the triggers to asthma?
Smoking, dust, pollen, exercise and pets.
What are the risk factors of asthma?
FHx of asthma, Hx of atopic conditions, living in a city, smoking, obesity.
What is the presentation suggesting diagnosis of asthma?
- Wheeze, dyspnoea, dry cough
- Diurnal variability so typically worse at night,
- Episodic symptoms
- Hx of atopic conditions e.g. hayfever, eczema, food allergies
- FHx of asthma
- O/E bilateral widespread wheeze on expiration
What are the investigations carried out to help diagnose asthma?
First line investigations
- Fractional exhaled nitric oxide: shows level of inflammation of airways
- Spirometry with bronchodilator reversibility
Main differences between asthma and COPD?
Age of onset - older in COPD, can occur at any age in asthma
Smoking Hx - significant in COPD
Atopy Hx - significant in asthma
Explain what peak flow test is and peak flow diary?
Peak flow test assesses how well your asthma is. Peak flow meter is a small device you blow into. It measures the fastest rate of air that you can blow out of lungs. Your peak flow readings will usually be low, and lower for than expected for your age, height and gender.
How to use peak flow meter?
How to use your peak flow meter
1 Pull the counter back as far as it will go
2 Stand, or sit upright (choose what’s easiest for you and always do it that way)
3 Take a deep breath
4 Make sure your mouth makes a tight seal around the mouthpiece
5 Blow as hard and fast as you can into the meter
6 Write down your score (the number next to the pointer)
7 Do this 3 times in a row so you get 3 scores – and use the highest of these
scores to fill in your diary.
How to use a peak flow diary?
Twice a day record peak flow score by marking a cross on the chart, use your best score out of three.
What is the Mx for newly diagnosed asthmatic patient?
1) SABA e.g. salbutamol
What is the step up therapy for asthmatic patients with symptoms >2 times a week or asthma uncontrolled with SABA alone?
2) Low dose ICS added on e.g. beclomethasone with SABA
What is the step up therapy if asthma uncontrolled with low dose ICS?
3) LTRA e.g montelukast added on with ICS and SABA
What is the step up therapy if asthma uncontrolled with low dose ICS and LTRA?
4) LABA e.g. salmeterol added on with ICS, LTRA, SABA
Explain what the blue inhaler does?
Short acting beta 2 adrenergic receptor agonists, for example salbutamol. These work quickly but the effect only lasts for short term like an hour. It acts on the smooth muscles of the airways to cause relaxation. This results in dilatation of the bronchioles and improves the bronchoconstriction present in asthma. They are used as “reliever” medication during acute exacerbations of asthma when the airways are constricting.
Explain what the brown inhaler does?
Inhaled corticosteroids (ICS), for example beclometasone. These reduce mucosal inflammation. widens airways. These are used as “preventer” medications to help reduced likelihood of attacks.
