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Respiratory Medicine > Asthma > Flashcards

Asthma Flashcards

1
Q

What is asthma?

A
  • Chronic inflammatory condition of airways causing episodic exacerbations of bronchoconstriction
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2
Q

What are the 3 factors that causes airway narrowing?

A
  • Bronchial muscle contraction
    • triggered by stimuli
  • Mucosal swelling
    • mast cell & basophil degranulation
  • Increased mucus production
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3
Q

What are the typical triggers of asthma?

A
  • Smoking, pollution
  • Infection - mainly viral
  • Night time or early morning
  • Exercise
  • Animals
  • Cold/damp
  • Dust
  • Stress
  • NSAIDs
  • B-blockers
  • Pollution
  • Occupational asthma (flour, latex, isocyanates, wood dust)
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4
Q

What are the RF for asthma?

A
  • Personal history of atopy.
  • Family history of asthma or atopy.
  • Inner city environment; socio-economic deprivation.
  • Obesity.
  • Viral infections in early childhood.
  • Smoking.
  • Maternal smoking.
  • Early exposure to broad-spectrum antibiotics
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5
Q

What are the sx of Asthma?

A
  • Wheeze
  • SOB
  • chest tightness
  • Cough
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6
Q

What features of the sx increase the probability of asthma?

A
  • Diurnal variation
  • response to exercise, allergen, cold air
  • present after taking aspirin or b-blocker
  • History of atopic disorder.
  • Family history of asthma and/or atopic disorder.
  • Widespread wheeze heard on auscultation of the chest.
  • unexplained low forced expiratory volume in one second (FEV1)
  • unexplained peripheral blood eosinophilia.
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7
Q

What signs will you find on examination for asthma?

A
  • Inspection
    • Tachypnoea
    • Hyperinflated chest
    • Expiratory wheeze
    • Prolonged expiration
    • Harrison’s sulcus seen in children with chronic asthma
  • palpation
    • Hyper-resonant percussion note
  • Auscultation
    • Reduced air entry
    • widespread polyphonic wheeze
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8
Q

What are the 3 characteristics of Asthma?

A
  • Reversible airflow limitation
  • Airway hyperresponsiveness
  • Inflammation of bronchi
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9
Q

How would you diagnose Asthma?

*this is for intermediate asthma probability

A
  • First line
    • Fractional exhaled nitric oxide (FeNO>40ppb)
    • Spirometry c bronchodilator reversibility
  • If diagnostic uncertainty
    • Peak flow variability - measured several times/day
    • Methacholine challenge test
  • Additional
    • TLCO - raised
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10
Q

What are the differentials for asthma in adults?

A
  • COPD
  • Asthma-COPD overlap syndrome
    • persistent airflow limitation with several features of asthma and COPD
  • Acute asthma
  • Acute Bronchitis
  • Heart Failure
  • CHD
  • Malignancy
  • GORD
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11
Q

What affects peak expiratory flow rate?

A
  • Sex
  • Age
  • Height
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12
Q

Why is spirometry preferred over PEFR?

A
  • offer clearer identification of airway obstruction
  • less effort-dependent
  • more repeatable
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13
Q

How does FeNO work?

A
  • Measures level of nitric oxide in the breath
  • Increased levels - lung inflammation and asthma
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14
Q

What are the list of medications used for asthma?

A
  • SABA - salbutamol
  • ICS - beclometasone
  • LABA - salmeterol
  • LAMA - tiotropium
  • LRA - montelukast
  • Phosphodiesterase inh. - Theophylline
  • Maintenance And Reliever Therapy (MART)
    • low dose ICS + fast acting LABA
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15
Q

What is the BTS/SIGN Stepwise ladder for mx of chronic asthma?

A
  1. SABA PRN. If use >3 times/week > step up
  2. Add low dose ICS (200-800mcg/day)
  3. Add LABA (Fostair - contains both ICS and LABA)
  4. Medium dose ICS/Montelukast
  5. Specialist referral
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16
Q
A
17
Q

What are the cx of asthma?

A
  • Pneumonia.
  • Pneumothorax.
  • Pneumomediastinum.
  • Respiratory failure and arrest
18
Q

What is brittle asthma?

A
  • Unstable/unpredictable asthma
19
Q

What are the features of moderate asthma?

A
  • PEFR 50-75% best or predicted
  • Speech normal
  • RR < 25 / min
  • Pulse < 110 bpm
20
Q

What are the features of severe asthma?

A
  • PEFR 33 - 50% best or predicted
  • Can’t complete sentences
  • RR > 25/min
  • Pulse > 110 bpm
21
Q

What are the features of Life-threatening asthma?

A
  • PEFR < 33% best or predicted
  • Oxygen sats < 92%
  • Silent chest, cyanosis or feeble respiratory effort
  • Bradycardia, dysrhythmia or hypotension
  • Exhaustion, confusion or coma
22
Q

What are the features of near fatal asthma?

A
  • Respiratory arrest
  • Raised PaCO2
  • Altered conscoiusness
  • Required mechanical ventilation
23
Q

What does TLCO measure?

A
  • gas transfer for the lungs from the alveoli into the capillaries
  • reflects how much oxygen is taken up into the red cells
24
Q

Aspirin can induce asthma and cause Samter’s triad. What is this triad?

A
  • asthma
  • aspirin sensitivity
  • nasal polyps
25
Q

What are the features of mild asthma?

A
  • PEFR >75%
26
Q

What are the causes of eosinophilia?

A
  • Asthma/COPD
  • Hayfever / allergies
  • Allergic Bronchopulmonary Aspergillosis
  • Churg-Strauss
  • Drugs (allopurinol)
  • Eosinophilic Myalgia Syndrome
  • Lymphoma
  • Parasite - Ascariasis
  • SLE
27
Q

What is the pathophysiology of Asthma

A
  1. Airway epithelial damage - shedding and subepithelial fibrosis, basement membrane thickening
  2. Inflammatory reaction - eosinophils, Th2, mast cells
  3. Inflammatory mediators release - histamine, leukotrines, prostaglandins
  4. Cytokines amplify inflammatory response
  5. Increase mucus secreting goblet cells, smooth muscle hyperplasia, hypertrophy
  6. Mucus plugging in fatal and severe asthma
28
Q

What are the criteria for safe asthma discharge after exacerbation?

A
  • PEFR >75%
  • Stop regular neb for 24hrs prior to discharge
  • Reassess inhaler technique and adherence - by inpatient asthma nurse
  • Provide PEFR meter and written asthma action plan
  • 5 days oral prednisolone
  • GP follow up within 2 days
  • Resp clinic follow up within 4 weeks
29
Q

Asthma can be classified into moderate, severe, life threatening and near fatal. Describe the features of each category

*think sx, vitals, sat, PEFR

A
30
Q

What parameters would you wan to maintain control in chronic asthma?

A
  1. Clinical: make sure no daytime symptoms, night-time waking or activity limitation
  2. Acute: make sure no asthma attacks and no need for rescue medication
  3. Medications: make sure no need for rescue medication, ensure minimal side-effects from medication
  4. Lung function: normal (PEF/FEV1)
31
Q
A
32
Q

How would you diagnose occupational induce asthma?

A
  • Serial peak flow measurements at work and at home
33
Q

What factors should be considered when considering asthma?

A
  • recurrent episodes of symptoms: may be triggered by viral infection, allergen exposure, NSAIDs/beta-blockers and/or exacerbated by exercise, cold air and emotion/laughter in children
  • recorded observation of wheeze: due to varying use of language this usually means wheeze documented by a clinician
  • symptom variability: asthma is generally worse at night or early in the morning
  • personal history of atopy: e.g. eczema/allergic rhinitis
  • absence of symptoms of alternative diagnosis: e.g. COPD, dysfunctional breathing or obesity*
  • historical record of variable peak flows or FEV1

Respiratory Medicine (12 decks)

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