asthma Flashcards
what is asthma
a reversible obstructive chronic inflammatory disease of the airways, involving intermittent attacks of bronchoconstriction.
symptoms of asthma
- wheeze
- dry cough
- sputum
- diurnal variability
- chest tightness
signs of asthma
tachypnoea, audible wheeze, hyper inflation of chest, hyper resonant percussion, decrease PEF (peak expiratory flow)
what are signs of a severe asthma attack
unable to complete full sentences, resp rate greater than 25 breaths per minute, pulse > 100 b/m, decreased PEF
what are signs of a life threatening asthma attack
silent chest, cyanosis, bradycardia, ABG pCO2> 5, pO2> 8, acidosis
when can you get asthma
can be early/late onset, atopic (tiggered by allergens) or non atopic (triggered by things such as exercise)
What occurs to the FVC in asthma
it remains normal
what occurs to the FEV1/FVC in asthma
FEV1/FVC< 75%
what occurs to the PEFR in asthma
moderate asthma <80%, severe <50%, life threatening <30%
what occurs during the provocation test if a patient has asthma
bronchospasm
what is used in the provocation test
histamine, metacholine or even exercise
How would you treat asthma
Step 1. Use SABA (salbutamol) and low dose ICS Step.2 add LABA (salmeterol) to low dose ICS (usually in an inhaler) Step 3. If no response to LABA, stop LABA and increase dose of ICS . If LABA benefiting , continue using and increase to medium dose of ICS. If it’s benefiting but there’s still little control, continue LABA and ICS and consider trial therapy for LTRA, SR- theophylline or LAMA Step 4. Refer patient to specialist care, increase ICS up to high dose, if not already add LTRA, ST-theophylline or LAMA Step 5. use daily steroid tablet in lowest dose possible, maintain high dose of ICS, consider other treatment to minimise use of steroid tablets
How would you treat acute asthma
Oxygen, Salbutamol, Hydrocortisone IV/ Prednisolone orally, Ipratropium, Theophylline, Magnesium Sulphate IV, Anaesthetic.
some things you should ask in history
family history of asthma, episodic, diurnal variability, associated atopy, wheezing
what is used to deliver ICS
either a Qvar or Kelhale
