Asthma Flashcards
What is asthma?
A disease of diffuse airway inflammation caused by a variety of triggering stimuli resulting in partially or completely reversible bronchoconstriction
Should ADLs be affected by asthma if it is well controlled?
NO - a person with well controlled asthma should be able to go about daily activities with NO symptoms and should not be affected
What can trigger asthma?
Infection Night time or early morning Exercise Animals Cold/damp Dust Stress
What are the signs of asthma?
Wheeze - can be bilateral, widespread and ‘polyphonic’
Tachypnoea and SOB
Tachycardia
Hyper-inflated chest therefore hyper-resonant on percussion
(A history of other atopic conditions such as eczema, hayfever and food allergies
Family history)
What investigations can be done for asthma?
Spirometry
- FEV1 reduced in asthma attack
- FVC nearly normal
- FEV1/FVC = reduced in attack
- With bronchodilator is there any reversibility?
PEFR
- for diagnosis 2-4 weeks, 2x a day
What are the first steps in the BTS ladder of asthma treatment?
1) Add short-acting beta 2 agonist inhaler (e.g. salbutamol) as required for infrequent wheezy episodes
2) Add a regular low dose corticosteroid inhaler (beclametasone)
What is the next step in the BTS ladder of asthma treatment after giving a SABA and ICS?
3) Add LABA inhaler (e.g. salmeterol). Continue the LABA only if the patient has a good response
4) Consider a trial of an oral leukotriene receptor antagonist (i.e. montelukast), oral beta 2 agonist (i.e. oral salbutamol), oral theophylline or an inhaled LAMA (i.e. tiotropium)
What are the final steps in the BTS ladder of asthma treatment?
5) Titrate inhaled corticosteroid up to “high dose”. Combine additional treatments from step 4. Refer to specialist
6) Add oral steroids at the lowest dose possible to achieve good control
What are the side effects of salbutamol?
Due to sympathetic/adrenergic activation it causes:
- Tachycardia
- Tremor
- Potentially: arrhythmias, myocardial ischaemia
- HYPOkalaemia
What side effects can occur with the use of theophylline?
- Toxicity can occur
- Tachycardia
- Arrhythmia
- Agitation
- Convulsions
- Hypokalaemia
What are the signs of a SEVERE asthma attack?
- Unable to complete sentences
- Resp. rate > 25
- Heart rate > 110
- PEFR 33-50% of predicted or best
What are the signs of a LIFE-THREATENING asthma attack?
- PEFR < 33% of predicted or best
- SpO2 < 92%
- PaO2 < 8kPa, PaCO2 (normal or high) > 4.6 kPa
- Silent chest (due to no air entry)
- Cyanosis
- Exhausation
- Altered consciousness level
- Hypotension
- Arrhythmia
What does ‘O SHIT ME’ consist of for immediate treatment of an acute exacerbation of asthma?
O = supplemental O2 (aim for 94-98%) S = salbutamol 5mg or terbutaline 10mg nebulised with O2 H = hydrocortisone IV 100mg (or prednisolone 40-50mg PO) I = Ipratropium 0.5mg 6 hourly (if severe/life threatening) T = Theophylline/aminophylline infusion 1g in 1L of saline 0.5ml/kg/h M = magnesium sulphate 1.2-2g IV over 20mins single dose (in those without good initial response) E = escalate care (intubation and ventilation)
When to reassess in asthma exacerbation?
Every 15 mins
If PEFR < 75% repeat salbutamol every 15-30 min or 10mg/hr continuously
What to do if asthma attack symptoms improve within 15-30 mins?
Continue salbutamol every 4-6hrs (with ipratropium if necessary)
Prednisolone 40-50mg PO OD for 5-7 days
Monitor O2
If PEFR is >75% then consider discharge
