Asthma - Adults and Kids Flashcards
what is the definition of asthma (3)
increased responsiveness of airway by stimuli
wide spread narrowing - changes in severity
what are the symptoms of asthma (in adults) (5)
expiratory wheeze
dry cough
chest tightness (central = cardiac, peripheral = respiratory)
dyspnoea (S.O.B)
expiration difficulties
what is the scale of acute asthma attacks - what else should you keep in mind when dealing with patents in these attacks
moderate, severe, life threatening, near fatal
that life threatening attack might not cause distress
what is asthmas mechanism of attack
airway inflammation by immune system
what is the prevalence of asthma in adults
5-10% of adults (most chronic UK condition)
it adulthood it effects females at a greater rate than males
what dose airway inflammation lead to (2)
widespread narrowing of airways
or increase airway reactivity
what does increased airway reactivity lead to (2)
spontaneous airway narrowing
airway narrowing by a stimuli
what is the difference between a normal airway and asthmatic airway
asthmatic airway has is thicker and chronically inflamed
what happens to a asthmatic airway during a attack
the relaxed smooth muscle tightens and traps air in the alveoli
what are the 3 proven risk factors for asthma
inherited genes
maternal smoking
occupation
what is atopy
an inherited predispostiton
produce IgE when exposed to environmental allergens
leads to hightend immune response
what is atopy
an inherited predisposition
produce IgE when exposed to environmental allergens
leads to heightened immune response
if first degree family memebers have asthma or another atopic disease what happens
the risk of you getting asthma increases
especially if mum has it (3X more likely compared to dad)
if first degree family members have asthma or another atopic disease what happens
the risk of you getting asthma increases
especially if mum has it (3X more likely compared to dad)
what dose maternal smoking cause in the child
higher risk of asthma
higher risk of attack due to higher airway responsiveness
child has reduced FEV1
what is the grandmother effect - what phenomenon is this
grandma smokes (on maternal side, more likely to get asthma)
epigenetic = hereditary trait that doesn’t relate to a change in DNA sequence
how much asthma is caused by occupation
10-15% of adult onset asthma
what are some examples of occupations at higher risk of asthma
backers , painters
what is the most important thing about making a asthma diagnosis
HISTORY!!!!
what relating to the symptoms of asthma can lead to a more likely diagnosis
variation of symptoms depending on time/season/work or weekend
asthma also has triggers what are some of them
exercise URTI - rhinovirus cold air cigarette smoke pets drugs
what drugs act as asthma triggers (2)
Beta blockers
aspirin
it wont be asthma if there is (3)
clubbing
stridor (something blocking the airway, pos. aspiration)
asymmetric expansion
what is asthma an example of
a obstructive disease
obstructs airflow
what tests are done to diagnoses asthma
spirometry
peak flow monitoring
CO gas transfer test
response to bronchodilator - beta2 agonist
what spirometry value is expected from asthma
FEC1/FVC = less than 70%
why is a peak flow test used
to determine if there is variability in airflow obstruction
what are the symptoms of a moderate attack
mildly greater symptoms than normal
PEF 50-75%
what are the symptoms of a sever attack
anyone
cant complete full sentences in 1 breath
HR over 110bpm
RR over 25 breaths per minute
PEF = 22-50% of predicted
what are the symptoms of a life threatening attack
grunting
impaired consciousness, confusion
silent chest
o2 saturation is lower than 92
PaO is lower than 60mmHg
what are the symptoms of a near fatal asthma attack
raised PaCO2
need for mechanical ventilation
what two drugs cause reversibility in asthma
beta2 agonists
corticosteroids
what is the Co gas transfer test used for
distinguishing between asthma and COPD
how dose the CO gas transfer test work
Co is passed on the Hb this is reduced in COPD and increased in asthma
what is the one thing to remember with asthma - NO..
no wheeze
no asthma
what are the similarities of adult asthma with children’s asthma (5)
its common
symptoms are the same
triggers, treatment and pathology are also all the same
what is the prevalence of asthma in children (2)
prevalence 0-15%
more boys than girls have asthma
what are the multiple hits that lead to asthma
genes
inherited abnormal lungs
early onset atopy
later exposures (rhinovirus, exercise, smoking0
why is rhinovirus a trigger
as asthma as a unusual response to infection due to the already inflamed airway
how can you tell there is a wheeze - is this different in kids
the wheeze is musical
kids airway narrower so more likely to be musical
what is a differential diagnosis for a child that has a wheeze
how would you diagnose
VIW - viral induced wheeze
as asthma is a dimmer switch of symptoms
VIW is a light switch - on/off when have a virus
what treatment is given for VIW
salbutamol
how do you confirm a asthma diagnosis
trial of inhaled cortical steroids
is there a asthma test for children
no
is there a lower age limit for diagnosis
no
what are ICS (inhaled cortical steroids) good for in peads
diagnostic
as a regular preventer
very safe
what should be added to a paediatric therapy routine if needing regular preventer (step 2)
add a beta 2 agonist
what are the adverse effects of ICS in peads
height suppression
what is step 3 in a peads asthma therapy
add LABA
what must you do for peads when giving the LABA for step 3
do not use without ICS
use as a fixed dose inhaler
what must kids used when using a pMDI
always use a spacer
what is the preferred method of treatment of peads asthma
pMDI with spacer
what other non medical management should be tried for kids asthma
stop smoking exposure
remove environmental triggers
what are the best treatment for step 1
SABA
how should steroids be delivered in acute asthma settings
oral steroids
how should steroids be delivered in chronic asthma settings
inhaled steroids
what is important about childhood asthma compared to adult asthma
its very steroid sensitive
