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Respiratory > Asthma > Flashcards

Asthma Flashcards

1
Q

Define asthma?

A

Chronic inflammatory airway disease characterised by variable reversible airway obstruction, airway hyper-responsiveness and bronchial inflammation

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2
Q

What are the genetic risk factors for asthma?

A

Family History

Atopy (tendency for T lymphocytes to drive production of IgE on exposure to allergens)

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3
Q

What are the environmental factors?

A 
House dust mites 
Pollen
Pets
Cigarette Smoke
Viral Respiratory Tract Infections
Aspergillus Fumigatus Spores
Occupational Allergens
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4
Q

What is the epidemiology of asthma?

A

Affects 10% of children
Affects 5% of adults
Prevalance appears to be increasing

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5
Q

What are the presenting symptoms of asthma?

A

Episodic History
Wheeze
Breathlessness
Cough (worse in the morning and at night)

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6
Q

What’s important to ask when talking about asthma?

A

Ask about previous hospitalisation due to acute attacks - this gives an indication of the severity of the asthma

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7
Q

What are the precipitating factors of Asthma?

A 
Cold
Viral Infection
Drugs (e.g. beta-blockers, NSAIDs)
Exercise
Emotions
Check for history of atopic disease (e.g. allergic rhinitis, uritcaria, eczema)
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8
Q

What are the signs of asthma on physical examination?

A 
Tachypnoea 
Use of accessory muscles 
Prolonged expiratory phase 
Polyphonic Wheeze 
Hyperinflated chest
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9
Q

What are the signs of a Severe Attack of Asthma?

A

PEFR < 50% predicted
Pulse > 110/min
RR > 25/min
Inability to complete sentences

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10
Q

What are the signs of a Life-Threatening Attack of asthma?

A 
PEFR < 33% predicted 
Silent Chest 
Cyanosis 
Bradycardia 
Hypotension 
Confusion 
Coma
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11
Q

What are the acute appropriate investigations for asthma?

A 
Peak Flow 
Pulse oximetry 
ABG 
CXR 
FBC 
CRP 
U&amp;Es 
Blood and sputum cultures
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12
Q

Why do we do a Chest X-Ray (CXR)?

A

To exclude other diagnoses e.g. pneumonia, pneumothorax

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13
Q

What might we see on a FBC?

A

Raised WCC if infective exacerbation

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14
Q

What are some of the investigations we might do in chronic asthma?

A

Peak flow monitoring
Pulmonary Function Test
Bloods to check Eosinophilia, IgE level, Aspergillus antibody titres
Skin Prick Tests

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15
Q

What would we expect to see if we monitored peak flow?

A

Often shows diurnal variation with a dip in the morning

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16
Q

Why do we do skin prick tests for asthma?

A

Helps identify allergens

17
Q

What is a management plan for acute asthma?

A 
ABCDE 
Resuscitate 
Monitor O2 sats, ABG and PEFR 
High-flow oxygen 
Salbutamol nebulizer 
Ipratropium Bromide 
Steroid Therapy
18
Q

What do we do if there’s no improvement after the acute management plan?

A

IV magnesium sulphate

19
Q

How much salbutamol nebulizer do we give in acute asthma?

A

5 mg, initially continously, then 2-4 hourly

20
Q

How much Ipratropium Bromide do we give?

A

0.5 mg 4 times a day

21
Q

What is the steroid therapy we give to patients to treat acute asthma?

A

100-200mg IV hydrocortisone

Followed by, 40mg oral prednisolone for 5-7 days

22
Q

What can you consider when thinking of the acute management plan for asthma?

A

Consider IV aminophylline infusion

Consider IV salbutamol

23
Q

What may be needed if the patient is getting exhausted?

A

Anaesthetic Help

24
Q

What is a bad sign in a patient having an asthma attack?

A

A normal PCO2

25
Q

Why is a normal PCO2 a bad sign in a patient having an asthma attack?

A

This is because during an asthma attack they should be hyperventilting and blowing off their CO2, so PCO2 should be low
A normal PCO2 suggests that the patient is fatiguing

26
Q

When would you give Antibiotics in an asthma attack?

A

You want to treat the underlying cause and if it is an infective exacerbation then you give antibiotics

27
Q

Why do we monitor electrolytes closely in an asthma attack?

A

Bronchodilators and aminophylline causes a drop in K+

28
Q

What may be needed in severe attacks of asthma?

A

Invasive Ventilation

29
Q

When do you discharge a patient after an acute asthma attack?

A

PEF > 75% predicted
Diurnal variation < 25%
Inhaler technique checked
Stable on discharge medication for 24 hours
Patient owns a PEF meter
Patient has steroid and bronchodilator therapy
Arrange follow-up

30
Q

How does chronic therapy of asthma work?

A

There are 5 steps and you start on the step that matches the severity of the patient’s asthma

31
Q

What is Step 1 in the chronic therapy of asthma?

A

Inhaled short-acting beta-2 agonist used as needed

If needed > 1/day then move onto step 2

32
Q

What is Step 2 in the chronic therapy of asthma?

A

Step 1 + regular inhaled low-dose steroids (400 mcg/day)

33
Q

What is Step 3 in the chronic therapy of asthma?

A

Step 2 + inhaled long-acting beta-2 agonist (LABA)
If inadequate control with LABA, increase steroid dose (800 mcg/day)
If no response to LABA, stop LABA and increase steroid dose (800 mcg/day)

34
Q

What is Step 4 in the chronic therapy of asthma?

A

Increase inhaled steroid dose (2000 mcg/day)

Add 4th drug (e.g. leukotriene antagonist, slow-release theophylline or beta-2 agonist tablet

35
Q

What is Step 5 in the chronic therapy of asthma?

A

Add regular oral steroids
Maintain high-dose oral steroids
Refer to specialist care

36
Q

What advice do you need to give to patients with chronic asthma?

A

Teach proper inhaler technique
Explain importance of PEFR monitoring
Avoid provoking factors

37
Q

What are some of the possible complications of asthma?

A 
Growth retardation 
Chest wall deformity (e.g. pigeon chest)
Recurrent infections
Pneumothorax 
Respiratory Failure 
Death
38
Q

What is the prognosis for patients with asthma?

A

Many Children improve as they grow older

Adult-onset asthma is usually chronic

Respiratory (17 decks)

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