asthma clinical features Flashcards
what are the key features of asthma
wheeze
variability
responds to treatment
what are the inconsistencies of asthma
transient vs persistant different severities diff age at onset heterogeneity in response diff triggers
what causes asthma
gènes 30-80% of causation 10 variants making modest contribution ADAM33, ORMDL3 interact w environment epugenetics
when is it likely to be asthma in children
examination unhelpful as they are unlikely to be wheezing no diagnostic asthma test in children - peak flow - spirometry lacks specified - exhaled nitric oxide unproven
what is NICE asthma
for children
spirometry
BDR - bronchodilator
feNO
peak flow
what is the BTS/SIGN guideline
same as NICE
what is an asthma cough like in kids
dry
usually nocturnal
exertional
how do you prevent a false positive response to treatment
use inhaler for 2 months then take a break to see if it was rly the treatment that helped symptoms
what is the onset of ‘asthma under 5 years
congénital CF PCD bronchitis foreign bodyv
what is onset of ‘asthma’ ‘for over 5s
dysfunctional breathing
vocal cord dysfunction
habitual cough
pertussis
what is atophy
the body’s predisposition to develop an antibody called igE in response to exposure to environmental allergens and is an inheritable trait
what does maternal smoking during pregnancy do
decrease FEV1
increase wheezy illness, airway responsiveness and asthma
what are proven rick factors for asthma
smoking when pregnant occupation obesity diet hygiène
what are some examples of triggers
exercise cold air smoke perfume urtis pets tree or pollen good drugs
what are important aspects of history to understand
past med history
what drugs they take (inhalers)
family history - anyone got it
social history - pets or tobacco
what can indicate asthma in examination
breathlessness on exertion
hyper inflated chest
wheeze
what else could it be ?
COPD bronchiectasus cystic fibrosis tumour or foreign body cardiac
what i vestigations can be done
full pulmonary function testing - carbon monoxide gas transfer - determine between COPD and asthma
reversibility to bronchodilator
variability of airflow obstruction
what are other useful investigations
chest x-ray
skin prick testing
total abs specific igE
full blood count
what signs do u assess for severity
ability to speak heart rate respiratory rate PEF oxygen saturation/arterial blood gases
what are life threatening signs
grunting impaired comsciousness, confusion or exhaustion bradycardia, arrhythmia or hypotension PEF<33% predicted cyanosis silent chest poor resp effect saO2 <92% paO2 <8kPa paCO2 normal (4.6-6kPa)
NEAR FATAL - raised paCO2 and need for mechanical ventilation
