Asthma And COPD Flashcards
What is asthma ?
An inflammatory disorder of the conducting airways. The airways become hyper - responsive and constrict easily in response to a wide range of exogenous and endogenous stimuli.
What are some types of asthma ?
Allergic asthma
Non-allergic asthma
Late onset asthma
Asthma with fixed airflow limitations
Asthma with obesity
What are some features of allergic asthma ?
Most easily recognised type
Majority begins at childhood
Associated with a family history of eczema, allergic rhinitis or food and drug allergy
Usually respond well to inhaled corticosteroids
What are some features of non-allergic rhinitis ?
Not associated with allergy
Sputum contains neutrophils, eosinophils and only a few inflammatory cells
Often respond less well to ICS
What are some features of late onset asthma ?
Onset is in adult life particularly in women
Tends to be non allergic
Higher dose of ICS often required
What are some features of asthma with fixed airflow limitations ?
Seen in patients with long standing asthma
Thought to be caused by airway remodelling
What are some features of asthma with obesity ?
Some obese asthmatic people suffer with prominent respiratory symptoms with little eosinophilic airway inflammation
What is the pathogenesis of atopic asthma ?
Airway inflammation caused by exposure to an environmental allergen. This occurs by IgE binding to bronchial mast cells resulting in degranulation and the release of pro-inflammatory mediators.
What are the 2 phases of inflammation ?
Acute phase
Delayed phase
What are the results of inflammation in asthma ?
Bronchial hyper-reactivity
Symptoms of cough, wheeze and chest tightness
Signs of variable polyphonic wheeze
What are some common environmental allergens in atopic asthma ?
Faeces of house dust mite
Cat salivary antigens
Pollen
Fungal spores
Grain antigens
Rat antigens
What occurs in the acute inflammatory response in asthma ?
It is characterised by bronchoconstriction and airway oedema. This begins within minutes of allergen exposure and resolves within hours. Cross linking of mast cell bound IgE allergen results in degranulation and the release of :
. Histamine
. Protease
. Tissue necrosis factor
. Platelet activating factor
What occurs in the delayed inflammatory response ?
The pro - inflammatory mediators such as interleukin-5 released by mast cells recruit, basophils and TH2-lymphocytes.
This results in :
. Ongoing inflammation
. Sensitisation of sensory nerve endings resulting in bronchial hyper-responsiveness
What are some risk factors for asthma ?
Host factors - genetics, obesity and sex
Infections
Having allergens
Diet
Stress
Exposure to tobacco smoke
What are some clinical factors of asthma ?
Wheezing
SOB
Chest tightness
Cough ( +/- sputum )
Worsening at night or in the early morning
Symptoms are triggered by a viral infection, exercise, allergen exposure or changes in the weather.
Follow a diurnal pattern
What are some features of a severe attack of asthma ?
Difficulty in speaking
Tachypnoeic and breathless
Tachycardia
Pulses paradoxus
Silent chest
Drowsiness
Cyanosis
What type of resp failure is a severe asthma attack ?
Type 2 resp failure
What are some differentials of asthma ?
URTI
Bronchiectasis
Cystic fibrosis
Hyperventilation
COPD
PE
What are some investigations to do when suspecting asthma ?
FeNo testing
Spirometry
Peak expiratory flow
What is the stepwise management for asthma ?
Step 1 - SABA PRN
Step 2 - low dose ICS
Step 3 - low dose ICS + LABA
Step 4 - medium dose ICS + LABA
Step 5 - high dose ICS + LABA
Consult an asthma specialist after step4
What is ‘complete control’ of asthma ?
No daytime symptoms
No night time waking due to asthma
No need for rescue medication
No asthma attacks
No limitation on physical activity
Normal lung function
What medication is given as an intermittent reliever for asthma ?
Prescribe an inhaled SABA for all patients with symptomatic asthma
What is given as a regular preventer for asthma ?
Inhaled ICS are recommended initially given twice daily
Other than ICS what are some other medications used as controllers in asthma ?
Leukotriene antagonists
Methotrexate
LABA in combination with inhaled glucocorticosteroids
What are some medications given as relievers in asthma care ?
SABA
Short acting theophylline
Inhaled Anticholinergics
Why are controllers given in asthma patients ?
To control clinical symptoms and reduce future risks such as exacerbations and decline in lung function
What is the aim of relievers for asthma patients ?
To reverse bronchoconstriction and relieve the symptoms quickly
When should a person with asthma be admitted to hospital ?
Any features of life threatening or near fatal asthma attack
What is the treatment of acute asthma in adults ?
Oxygen
High dose SABA
Ipratropium bromide
Prednisolone
What factors should be monitored and recorded in primary care for an asthmatic patient ?
Symptomatic control
Lung function assessed by spirometry or peak flow
Any exacerbations
Inhaler technique
Adherence
Bronchodilator reliance
What is COPD ?
A condition characterised by airflow obstruction which is progressive not fully reversible and does not change markedly over several months.
What are some causes of COPD ?
Smoking
Indoor air pollution
Occupational exposure to toxins
Outdoor air pollution
Genetic factors
Infections
What are some pathological changes seen in COPD ?
Chronic inflammation - increased numbers of specific inflammatory cell types in different parts of the lung
Structural changes due to repeated injury
Mucous hypersecretion
Ciliary dysfunction
Airflow limitation and hyperinflation / air trapping
What are some clinical features of COPD ?
Chronic and progressive dyspnoea
Chronic cough
Regular sputum production
Wheezing
Chest tightness
Fatigue
Weight loss ( severe COPD )
What are some signs of COPD ?
Hyper inflated chest
Wheeze
Purse lip breathing
Use of accessory muscles
Peripheral oedema
Raised JVP
What are some investigations you should perform when suspecting COPD ?
Spirometry
CXR
FBC
Sputum culture if present
What are some differentials of COPD ?
Asthma
Bronchiectasis
Congestive HF
Carcinoma of the bronchi
What is the goals of management of COPD ?
Reduce long term lung function decline
Prevent and treat exacerbations
Reduce hospitalisations and mortality
Relieve dyspnoea
Improve exercise tolerance
Prevent and treat complications
What are some non-pharmacological management options for COPD ?
Smoking cessation
Recommend physical activity
Pulmonary rehabilitation
Up to date vaccinations
What is the pharmacological management of COPD ?
Bronchodilators -
- SABA
- LABA
- Anti-muscarinics
Anti-inflammatory -
- ICS
- Oral glucocorticoids
- mucolytics
What is the follow up of COPD in primary care ?
Should be reviewed annually or more frequently if required
What should be covered in a routine follow up of COPD ?
Smoking status
Symptom control
Presence of complications
Inhaler technique
What are some complications of COPD ?
Respiratory failure
Pulmonary artery hypertension
Cor pulmonale
Pneumothorax
Weight loss
What palliative care can be given in end stage COPD ?
Treatment for dyspnoea - opiates, morphine, oxygen , pulmonary rehab
Nutritional support
