Asthma Flashcards
British thoracic society guidelines for asthma control
1 - mild/intermittent - PRN inhaled B2 agonist (salbutamol)
2 - reg preventer - above + inhaled low-dose steroid (beclometasone 200-800 micrograms/day)
3 - initial add-on - above + reg long acting B2 agonist (salmeterol 50 micrograms/12h)
4 - persist poor control - high dose inh.steroid (2000 micrograms/day) & PO theophylline or montelukast
5 - oral steroid (prednisolone)
Asthma
A chronic inflammatory airway condition with reversible airway obstruction and bronchospasm
Attacks will present with wheezing, coughing and SOB
Will show obstructive spirometry with normal FVC and TCO which is reversible with salbutamol
Side effects of B2 agonists
Salbutamol or salmeterol
Postural tremor
Tachycardia
Hypocalcaemia and hyperglycaemia
Side effects of inhaled steroids
Beclamethasone or budesonide
Oral candidiasis (can also occur in HIV)
Dysphonia
Oral stomatitis
Side effects of theophylline
A methylxanthine (PDE inhibitor and adenosine antagonist)
Arrhythmias
Seizures
Narrow therapeutic window – interacts with P450s and several other drugs
Criteria for ‘severe’ asthma
Peak flow 33-50% predicted
HR > 110
RR >25
Unable to complete sentences
Criteria for ‘life threatening’ asthma
Peak flow 6kPa
Silent chest and confused
Treatment for acute asthma attack
Stage 1:–> Oxygen,Salbutamol & ipratropium nebs, IV hydrocortisone. CXR–>exclude pneumathorax+ABG for severity
Stage 2:–> repeat nebs or use IV salbutamol if nebs unusable
Stage 3:–> IV magnesium (prev aminophylline)
Stage 4:–> mechanical ventilation
Specific questions for asthma history
Precipitants Diurnal variation Exercise Disturbed sleep Acid reflux Atopy Pets/carpet/occupational exposure
Tests for asthma
PEF sputum culture FBC U&E CRP ABG
Churg Strauss syndrome
Adult onset asthma, eosinophillia and vasculitis
Gives a septic shock picture
Rx: steroids, ?biologics
Treatment of asthma during pregnancy
As normal including steroids
