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Respiratory > Asthma Clinical Features Adults > Flashcards

Asthma Clinical Features Adults Flashcards

1
Q

What causes the airways to become inflamed?

A

The immune system

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2
Q

What does the increased airway reactivity cause?

A

Airway narrowing - resulting spontaneously or from stimuli

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3
Q

What is the prevalence of asthma?

A

Children 10 - 15% M > F

Adults 5 - 10% F > M

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4
Q

What are the genetic risk factors for asthma?

A

Atopy- Inherited tendency to develop IgE response to allergens

Associated with allergic rhinitis, asthma hay fever, eczema

Strongest risk factor: personal, familial atopic tendency - Maternal atopy most influential (3x father)

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5
Q

What are the symptoms of Asthma?

A

Wheeze

Shortness of breath

Chest tightness

Cough

usually dry Sputum

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6
Q

What type of variation in asthma might help determine the trigger?

A

Daily variation- nocturnal/morning

Weekly variation- Occupation, weekends, Holidays

Annual Variation (environmental allergens)

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7
Q

What are essential investigation for asthma diagnosis?

A

Airflow obstruction

Variability and reversibility of airflow obstruction

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8
Q

What is the effect of maternal smoking on FEV1?

A

FEV1 ia reduced

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9
Q

What is the effect of maternal smoking on Wheezy illness, airway responsiveness, asthma and severity?

A

All increase

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10
Q

What is known as the Grandmother effect?

A

Grandchildren are far more likely to suffer from asthma if their grandmothers smoked while pregnant.

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11
Q

What are the three proven risk factors?

A

Smoking, genetic and occupation

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12
Q

What are possible risk factors for asthma?

A

Obesity,

diet,

reduced exposure to microbes/microbial products,

indoor pollution,

environmental allergens

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13
Q

What is body mass index positively associated with?

A

Asthma

Wheezing

Airway hyperactivity

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14
Q

what is the hygiene hypothesis

A
  • Reduced exposure to microbes/ microbial products•
  • Children born on farms less likely to develop asthma

Microbial diversity also important in reducing risk of asthma and allergy

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15
Q

What feature of the dust mite is allergenic?

A

Protease in droppings

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16
Q

What influence does affluence have on allergens?

A

Increases the likelihood of sensitisation to local allergens

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17
Q

What is the most important consideration when making an asthma diagnosis?

A

HISTORY

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18
Q

What common health conditions are important to consider when diagnosing asthma?

A

Childhood asthma, bronchitis

eczema

hayfever

Hayfever and eczema are other atopic conditions

19
Q

What features of drug use are important to consider when diagnosing asthma?

A

Current inhalers (technique, dosage, compliance)

Beta blockers

Aspirin

NSAIDS (Nonsteroidal anti-inflammatory drugs)

Effects of previous drugs

20
Q

When is it unlikely to be asthma?

A

Finger clubbing

Stridor

Assymetrical expansion

Dull percussion note (lobar collapse, effusion)

Crepitations

21
Q

Investigations

How can you determine if someone has obstructed airways?

A

Spirometry

FEV1 is less then 80% predicted

FEV1/FVC ratio<70%

22
Q

Investigations

What do FEV1 and FVC tell us respectively?

A

Airway diameter

Lung Capacity

23
Q

Investigations

After confirmation of obstructed airways, what is your next step in the diagnosis of asthma?

A

Full pulmonary function tests

Then confirmation of reversibility with B2 agonists

24
Q

Investigations

If airways are not obstructed what is your next step in diagnosis?

A

Peak flow monitoring

Bronchial provocation with nitric oxide

25
Q

Investigations

What is a bronchial provocation test?

A

Evaluates lung sensitivity

spirometry results compared before and after you inhale a spray

Shows changes in airway diameter

Spray is usually metahacholine.

26
Q

Investigations

What is the purpose of full pulmonary funciton testing?

A

Excludes COPD and emphysema

27
Q

What are the tests involved in the full pulmonary funciton testing?

A

Lung volumes

Carbon monoxide gas transfer

28
Q

What is gas trapping?

A

Abnormal retention of air in the lungs where it is difficult to exhale completely

Observed in obstructive lung diseases such as asthma, bronchiolitis obliterans syndrome and chronic obstructive pulmonary diseases such as emphysema and chronic bronchitis.

29
Q

How is lung residual volume measured of the lungs?

A

Helium dilution technique

The patient inhales breaths of helium and oxygen in a closed system. Concentration of helium will decrease as it diffuses into all areas of the lung. The amount of concentration reduction it indicative of the residual capacity

30
Q

What is the residual volume and total lung capacity of a patient who is asthmatic?

A

Increased residual volume

Increased total lung capacity

RV/TLC > 30%

31
Q

What is the carbon monoxide gas transfer used to determine?

A

Ability of gas transport across the alveoli,

alveoli are unaffected in asthma

only the airway is affected.

32
Q

When will there be no response to bronchodilator?

A

When there is no bronchoconstriction or severe bronchoconstriction

33
Q

When spirometry is normal why is it important to measure peak flow?

A

Looking for variability in airflow obstruction

Lung function in clinic may(usually) be normal

34
Q

What test is likely to increase use of according to NICE?

A

Exhaled nitric oxide tests

35
Q

How would you read the methacholine responsiveness?

A

Reduction of FEV1 by over 20%

36
Q

What is the effect of methachoine?

A

Acts like acetylcholine to constrict airways

Nebulising the substance you think they are susceptible to can be useful too.

37
Q

What is the exhaled nitric oxide in an asthmatic patient compared to normal?

A

Increase in nitric oxide

38
Q

What are the other useful investigations?

A

Chest X-ray - Hyperinflated, hyperlucent

Skin prick testing (atopic status)

Total and specific IgE (atopic status)

Full blood count- Eosinophilia (atopy)

39
Q

What are the most important considerations when diagnosing acute asthma?

A

Objective > subjective

Ability to speak

Heart rate

Respiratory rate

PEF (peal expiratory flow)

Oxygen saturation / arterial blood gases

40
Q

Acute asthma

What are the moderate symptoms in acute asthma

A

Able to speak

HR< 110

RR<25

PEF 50-75%

Sa02> 92

Pa02>8kPa

41
Q

acute asthma

What are the severe symptoms in acute asthma

A

Inability to complete sentences in one breath

HR>110

RR>25

PEF 33-50%

  • SaO2 ≥ 92%
  • PaO2 ≥ 8kPa
42
Q

What are the life threatening symptoms of asthma

A
  • Grunting
  • Impaired consciousness,

confusion

  • Bradycardia/ arrhythmia/ hypotension
  • PEF < 33% predicted or best
  • Cyanosis
  • Silent chest
  • Poor respiratory effort•
  • SaO2 < 92% (definitely needs blood gas!)
  • PaO2 < 8kPa
  • PaCO2 normal (4.6 - 6.0kPa)
43
Q

What are the near fatal symptoms of acute asthma

A

Raised PaC02

Respiratory (30 decks)

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