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Respiratory Block > Asthma clinical features - adults and children > Flashcards

Asthma clinical features - adults and children Flashcards

1
Q

Definition of asthma

A

A disease characterised by an increased responsiveness of the trachea and bronchi to various stimuli and manifested by a widespread narrowing of airways that changes in severity either spontaneously or as a result of therapy

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2
Q

What mediates the airway inflammation In asthma?

A

Immune system

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3
Q

Name the 2 effects of the immune system in asthma

A

Widespread narrowing of airways and increased airway reactivity

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4
Q

Give examples of spontaneous and stimuli airway narrowing

A
  • during the night

- pollen

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5
Q

What is the percentage of children with asthma and male and female ratio

A

10-15% and M>F

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6
Q

What is the percentage and gender prevalence in adult asthma?

A

5-10% and F>M

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7
Q

How many people are receiving asthma treatment?

A

5.4 million people - 1.1m kids and 4.3m adults

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8
Q

How many deaths per year from asthma?

A

About 1000 most being >60 smokers

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9
Q

Genetic - atopy

A

Inherited tendency to IgE response to allergens

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10
Q

If you have asthma what other conditions are related and likely to have?

A

Eczema, hayfever and food allergies

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11
Q

Are mothers or fathers more influential for atopy?

A

Mother - 3 times more than father

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12
Q

Occupational asthma

A

10-15% of adult onset and due to interactions with smoke and atopy

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13
Q

Name jobs most likely to be at risk of occupational asthma

A

Bakers, lab animal workers, painters, fish workers

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14
Q

Smoking - mother and grandmother

A

Maternal smoking and grandmother smoking in pregnancy highly increases chance of asthma

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15
Q

Why if your mother/grandmother smoked in pregnancy are you likely to get asthma?

A

Epigenetic modification of oocytes

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16
Q

Name 2 possible risk factors for asthma

A

Diet and obesity

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17
Q

Why are children born on farms less likely to get asthma?

A

Exposure to microbes/microbial products meaning microbial diversity

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18
Q

Name some indoor pollutants

A

Volatile organic compounds, formaldehydes and fragrances

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19
Q

Name 3 environmental allergens

A

House dust mite, cats and grass pollen

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20
Q

House dust mite

A

Allergen is protease in droppings in pillows/bed

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21
Q

Does exposure cause atopy?

A

No

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22
Q

Name the 5 symptoms of asthma

A 
Wheeze 
Severe shortness of breath
Chest tightness
dry cough
occasional sputum
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23
Q

List some triggers of asthma

A

Exercise, cold air, smoke, perfume, pets

24
Q

Daily variation

A

Nocturnal/ early morning

25
Weekly variation
Occupation and holidays
26
Annual variation
Environmental allergens
27
Past medical history
Childhood asthma, bronchitis | eczema, hayfever
28
Drugs/ medication
Current inhalers, check technique, compliance beta blockers, aspirin, NSAIDS Effects of previous drugs and inhalers
29
Family medical history
Atopic disease
30
Personal/social history
Smoking, pets, occupation, psychosocial
31
What 2 things are you looking for evidence for when investigating asthma?
Airflow obstruction | Variability/reversibility of airflow obstruction
32
Describe what you would expect FEV1/FVC to be in an asthmatic
FEV1<80% and ratio <70% | May be normal due to variable AFO
33
What would you do if the FEV1/FVC values were lower than expected?
Do full pulmonary testing to exclude COPD/ emphysema
34
Name 2 techniques used in the full investigation
Lung volumes ( helium dilation) and Carbon monoxide gas transfer
35
What 2 substances would show to reverse the bronchoconstriction and would be used?
beta 2 agonist | steroids
36
What would be the course of action if the spirometry results were normal?
Look for variability in airflow obstruction | Peak flow meter and chart twice daily for 2 weeks
37
What does the peak flow meter show when analysed?
Morning/nocturnal dips Decline over weeks/days variability>20% ( high-low)/high
38
How would you confirm occupational asthma?
Serial peak flow readings - every 2 hours for minimum of 5 days with 2 pairs of exposed and unexposed periods
39
State 2 specialist investigations
Airway responsiveness to methacholine/histamine | Exhaled nitric oxide (NO)
40
What should there be positive response and no response to in occupational asthma?
Positive - colophony | no response - methyl ester, maleic ester
41
What would you look for in a chest xray?
Hyperinflated and hyperlucent
42
What would you look for in full blood count?
Eosinophilia
43
Name some objective parameters
Ability to speak, heart and respiratory rate, PEF and oxygen saturation
44
If no wheeze is present can it still be asthma?
No
45
What are the 3 key words with asthma?
Wheeze, variability and responsive ( to treatment)
46
List the 5 similarities with adults and children asthmatics
``` Symptoms common same triggers same treatment same pathology ```
47
List the 3 differences between child and adult asthma
Gender ( boys and women) Severe asthma Occupational asthma uncommon
48
What percentage of UK children are on inhaled steroids?
5%
49
Name the 4 contributors to the multiple hit theory
Genes Inherently abnormal lungs Early onset atopy Later exposures eg rhinovirus, smoke
50
Is a stethoscope ever important in asthma?
No
51
Name the 3 changes to the airway which causes wheeze
Bronchoconstriction Airway wall thickening Luminal secretions
52
Shortness of breath
At rest and sooking of ribs with wheeze
53
Cough
Nocturnal, dry
54
Does atopy cause asthma?
No, encountering an allergen does not mean an allergic reaction will occur
55
Viral induced wheeze
Similar to asthma and can treat with salbutamol
56
Bronchitis
Loose rattly cough and vomit due to disturbed mucociliary clearance but will cure itself
57
Pertussis
Coughing fits and vomit | Vaccination reduces risk and severity

Respiratory Block (29 decks)

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