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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
Q

Weekly variation

A

Occupation and holidays

26
Q

Annual variation

A

Environmental allergens

27
Q

Past medical history

A

Childhood asthma, bronchitis

eczema, hayfever

28
Q

Drugs/ medication

A

Current inhalers, check technique, compliance beta blockers, aspirin, NSAIDS
Effects of previous drugs and inhalers

29
Q

Family medical history

A

Atopic disease

30
Q

Personal/social history

A

Smoking, pets, occupation, psychosocial

31
Q

What 2 things are you looking for evidence for when investigating asthma?

A

Airflow obstruction

Variability/reversibility of airflow obstruction

32
Q

Describe what you would expect FEV1/FVC to be in an asthmatic

A

FEV1<80% and ratio <70%

May be normal due to variable AFO

33
Q

What would you do if the FEV1/FVC values were lower than expected?

A

Do full pulmonary testing to exclude COPD/ emphysema

34
Q

Name 2 techniques used in the full investigation

A

Lung volumes ( helium dilation) and Carbon monoxide gas transfer

35
Q

What 2 substances would show to reverse the bronchoconstriction and would be used?

A

beta 2 agonist

steroids

36
Q

What would be the course of action if the spirometry results were normal?

A

Look for variability in airflow obstruction

Peak flow meter and chart twice daily for 2 weeks

37
Q

What does the peak flow meter show when analysed?

A

Morning/nocturnal dips
Decline over weeks/days
variability>20% ( high-low)/high

38
Q

How would you confirm occupational asthma?

A

Serial peak flow readings - every 2 hours for minimum of 5 days with 2 pairs of exposed and unexposed periods

39
Q

State 2 specialist investigations

A

Airway responsiveness to methacholine/histamine

Exhaled nitric oxide (NO)

40
Q

What should there be positive response and no response to in occupational asthma?

A

Positive - colophony

no response - methyl ester, maleic ester

41
Q

What would you look for in a chest xray?

A

Hyperinflated and hyperlucent

42
Q

What would you look for in full blood count?

A

Eosinophilia

43
Q

Name some objective parameters

A

Ability to speak, heart and respiratory rate, PEF and oxygen saturation

44
Q

If no wheeze is present can it still be asthma?

A

No

45
Q

What are the 3 key words with asthma?

A

Wheeze, variability and responsive ( to treatment)

46
Q

List the 5 similarities with adults and children asthmatics

A 
Symptoms
common
same triggers 
same treatment
same pathology
47
Q

List the 3 differences between child and adult asthma

A

Gender ( boys and women)
Severe asthma
Occupational asthma uncommon

48
Q

What percentage of UK children are on inhaled steroids?

A

5%

49
Q

Name the 4 contributors to the multiple hit theory

A

Genes
Inherently abnormal lungs
Early onset atopy
Later exposures eg rhinovirus, smoke

50
Q

Is a stethoscope ever important in asthma?

A

No

51
Q

Name the 3 changes to the airway which causes wheeze

A

Bronchoconstriction
Airway wall thickening
Luminal secretions

52
Q

Shortness of breath

A

At rest and sooking of ribs with wheeze

53
Q

Cough

A

Nocturnal, dry

54
Q

Does atopy cause asthma?

A

No, encountering an allergen does not mean an allergic reaction will occur

55
Q

Viral induced wheeze

A

Similar to asthma and can treat with salbutamol

56
Q

Bronchitis

A

Loose rattly cough and vomit due to disturbed mucociliary clearance but will cure itself

57
Q

Pertussis

A

Coughing fits and vomit

Vaccination reduces risk and severity

Respiratory Block (29 decks)

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