Asthma and drugs Flashcards
What causes asthma? 6
Inherited Modern lifestyles Smoking during pregnancy Environmental pollution Viral infection Irritants found in the workplace
How many asthmatics are there in the UK?
5.4 million
What proportion of adults and children have asthma?
1 adult in 12
1 child in 11
What four presentations can an asthmatic present?
Moderate
Severe
Life threatening
Near fatal
What must we be aware of when being told a patient has asthma?
Asthma is rare in the older population so Particularly in older patients asthma is often mis diagnosed. Many symptoms may point to asthma but in fact be another respiratory conditions.
What signs present a moderate asthma attack?
Talking in sentences SPO2>92% PEFR>50% best or predicted (peak expiratory flow rate) Heart rate 5 Resp rate 5
What signs present an acute asthma attack?
Can’t complete sentences in 1breath or too breathless to talk or feed.
SPO2 140/min ages 2-5 >125/min aged >5
Resp rate >40/min ages 2-5 >30/min aged >5
What signs present a life threatening asthma attack?
Silent chest
Cyanosis
SPO2
What is Aetiology?
The study of the cause of a disease
What is pathophysiology?
Study of the progress of the disease
How does asthma progress.. 6steps.
Airways almost continuously sensitive and inflamed
Trigger causes bronchospasm
Inflammation increases and mucus secreted.
Bronchial muscles.
Hyperinflation (of the lungs) can breath in but can’t breath out.
Reduction in tidal volume.
What cells secrete mucus?
Goblet cells
What causes the asthma expiratory wheeze.
Hyperinflation.
Define hyperinflation.
…
What triggers asthma? 8
Pollen Cigarette smoke Dust mites Pets Mould Exercise Stress Sudden change in temperature.
Define Asthma.
An inflammatory disease of the airways associated with episodes of reversible over-reactivity of the airway smooth muscle.
A narrowing of the medium to small size airways, due to muscle spasm, oedema and blockage by inflammatory cells.
What are the clinical signs of a near fatal asthma attack?
Acidotic state and/or requiring mechanical ventilation with raised inflation pressures.
Blue skin (cyanosis)
What is the red flag that an asthma patient requires an urgent asthma review.
Use of over 12 reliever inhalers in a year
What are the medical risk factors for developing near-fatal asthma?
Previous near-fatal asthma
Previous hospital admission for asthma especially in the last year requiring three or more classes of asthma medication.
Heavy use of beta2 agonist (reliever medication)
Brittle asthma
Repeated ED attendance for asthma care especially in the last year.
Name 5 psychological/behavioural risk factors for developing near-fatal asthma?
Non-compliance with treatment or monitoring Failure to attend appointments Fewer GP contacts Frequent home visits Self discharge from hospital Psychiatric illness or self harm Current or recent tranquilliser use (ketamine) Denial Alcohol or drug abuse Obesity Learning difficulties Employment problems Social isolation Childhood abuse Sever domestic, marital or legal stress.
What is brittle asthma?
A group of asthmatics who are on the verge of having severe life threatening or fatal asthma attacks once a month.
What % of fatal asthma patients were not recorded as having an asthma review in the past 12months?
57%
Asthma patients should be encouraged to know; Why, How and When. Elaborate.
Why: they take their medication
Preventer vs reliever
How: inhaler technique should be reviewed regularly
When: to take their medication - during attacks
And increasing preventer medication prior to their triggers taking effect.
How do we manage mild/moderate asthma?
Move to a calm quiet environment
Encourage use of own inhaler-2puffs/2mins a max of 10puffs
High % oxygen therapy.
Consider nebuliser salbutamol
(If none of the above work then move onto severe asthma mgmt)
How do we manage severe asthma?
Consider nebulised ipratropium bromide
Continue with salbutamol nebulisation unless clinically significant side effects occur
(If no success then move onto life threatening steam mgmt)
How do we manage life threatening asthma?
Consider administering adrenaline
If no success move onto near fatal asthma mgmt
How do we manage near-fatal asthma?
Consider positive pressure ventilation using a bag valve mask and ‘T’ piece.
What observations need to be taken for an asthma patient before and after treatment?
Pulse rate
Resp rate
Peak expiratory flow (PEF)
EtCO2 & SpO2
What drugs can we administer to aid an asthma attack.
Adrenaline 1:1000
Ipratropium bromide
Salbutamol
How is adrenaline 1:1000 administered?
intramuscular
- upper arm
- buttock
- thigh
What are the side effects of adrenaline 1:1000?
None
What is the dosage of adrenaline 1:1000 for adults?
500mcg
Repeat after 5minutes
What are the adrenaline 1:1000 indications?
Life threatening asthma
Failing ventilation
Continued deterioration despite nebulisation therapy.
What are the adrenaline 1:1000 contraindications?
Repeated doses in hypothermic patients.
What are the cautions associated with administering adrenaline 1:1000?
Beta blockers and Tricyclic antidepressants
What are the therapeutic effects of Adrenaline 1:1000
Relieves bronchospasm in acute severe asthma.
Sympathy mimetic that stimulates both alpha and beta receptors
