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Respiratory block > Asthma clinical features in adults > Flashcards

Asthma clinical features in adults Flashcards

1
Q

What is asthma ?

A

History of respiratory symptoms such as :

- wheezing
- SOB
- coughing
- chest tightness
- together with difficulty in expiration
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2
Q

What is the epidemiology of asthma ?

A

Children- 10-15% - M>F
Adults- 5-10%- F>M
Dangerous- 3 deaths/day

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3
Q

What is the pathophysiology of asthma ?

A

Airway inflammation mediated by the immune system —> narrowing of airways
—> increased airway reactivity
I
V
Airway narrowing
I I
V V
spontaneously stimuli

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4
Q

What are the three proven risk factors ?

A

Smoking
Genetics
Occupation

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5
Q

What are the hereditary risk factors of asthma ?

A

Atopy is body’s predisposition to develop an antibody- IgE in response to exposure to :

- environmental allergens and is an inherited trait- allergic rhinitis, eczema, hay fever 
- increased risk of asthma if 1st degree family member has asthma or atopic disease
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6
Q

How is smoking a risk factor of asthma ?

A 
Maternal smoking during pregnancy:
    - decreased FEV1
    - increased wheeze
    - increased airway responsiveness
    - increased asthma 
likely an epigenetic phenomena
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7
Q

What allergens can occupation expose you to ?

A 
Isocyanates (paints)
Colophony (welding solder flux)
Laboratory Animals
Grains
Enzymes
Drugs 
Crustaceans
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8
Q

What is the most important clinical aspects of asthma ?

A

History

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9
Q

What are the symptoms of asthma ?

A 
Wheeze
SOB, severity 
Chest tightness
Cough, paroxysmal, usually dry 
Sputum (occasional)
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10
Q

What are some triggers of asthma symptoms ?

A 
Exercise
Cold air
Cigarette smoke
Perfumes
URTIs
Pets
Tree or grass pollen 
Food
Drugs (aspirin/ NSAIDs)
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11
Q

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

A

Daily- nocturnal/ early morning
Weekly- occupation, better at weekends/holidays
Annual- environmental triggers

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12
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/ inhalers

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13
Q

What aspects of social history are important to consider when diagnosing asthma ?

A

Smoking
Pets
Occupations past/present
Psychosocial aspects - Psychosocial profile can affect asthma

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14
Q

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

A

Childhood asthma, bronchitis
Eczema
Hay-fever

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15
Q

What are some differential diagnosis when investigating asthma ?

A

Generalised airflow obstruction:

- COPD
- bronchiectasis 
- cystic fibrosis

Localised airway obstruction (inspiratory stridor= large airways)

- tumour
- foreign body

Cardiac

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16
Q

When is it unlikely to be asthma ?

A

Cervical lymphadenopathy

Stridor

Asymmetrical expansion

Dull percussion note (lobar collapse, effusion)

Crepitations - crackling or rattling sounds) (bronchiectasis, CF, alveolitis, LVF)

17
Q

What are the two positive findings for asthma ?

A

Airflow obstruction

Variability and or reversibility of airflow obstruction

18
Q

How can spirometry determine if someone has obstructed airways ?

A

FEV1 < 80% predicted

FEV1/FVC < 70%

19
Q

What do FEV1 and FVC tell us respectively ?

A

Airway diameter

Lung Capacity

20
Q

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

A

Full pulmonary function tests

Confirmation of reversibility with B2 agonists and steroids

21
Q

What is reversibility to bronchodilators ?

A

Response to bronchodilator
Baseline, 15 mins post 400microg inhaled salbutamol
Baseline, 15 mins post neb 2.5-5mg salbutamol
Interpretation:
- significant reversibility-> FEV1> 200ml and FEV1 > 12% baseline

22
Q

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

A

Peak flow monitoring

Bronchial provocation with nitric oxide

23
Q

What is the purpose of full pulmonary function testing ?

A

Excluding COPD/emphysema

24
Q

What is reversibility to oral steroids ?

A 
Response to oral corticosteroids (anti-inflammatory)
Separates COPD from asthma
0.6mg/kg prednisolone 14 days 
 Peak flow chart and meter 
 Baseline and 2 weeks spirometry
25
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

26
Q

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

A

Lung volumes

Carbon monoxide gas transfer

27
Q

What is the carbon monoxide gas transfer used to determine ?

A

Ability of gas transport across the alveoli, alveoli are unaffected in asthma it is only the airway that are affected

28
Q

What are some specialist test to determine airway responsiveness ?

A

Methacholine
Histamine
Mannitol
Exhaled FeNO

29
Q

How would you read the methacholine responsiveness ?

A

Reduction of FEV1 by over 20%

30
Q

What is the effect of methacholine ?

A

Acts like acetylcholine to constrict airways

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

31
Q

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

A

Increase in nitric oxide

32
Q

What are some other useful investigation ?

A 
Chest X-ray:
    - hyperinflated, hyperlucent
    - no effusion, collapse, opacities, interstitial changes
Skin prick test:
    - atopy status 
Total and specific IgE:
    - atopy status 
Full blood count:
    - eosinophilia (atopy)
33
Q

How can the severity of asthma be assessed ?

A

Moderate Severe Life threatening

Airway- PEFR 20-75 % PEFR 33-50% PEFR <33%

Breathing- RR <25 RR >25 Rest effort decreased, silent chest

Circulation- Pulse <110 Pulse > 110 Pulse <60,

Disability- Able to speak, Can’t complete grunting, exhaustion, confuse
complete sentences sentence in 1 breath

Exhange, gas- SaO2 > 92% SaO2 > 92% SaO2 <92%
(no need ABG) PaO2 > 8kPa PaO2 <8kPa
PaO2 >8kPa PaCO2 normal (4.6-6kPa)

34
Q

How is fatal asthma assessed ?

A

Raised PaCO2

Need for mechanical ventilation

Respiratory block (38 decks)

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