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Respiratory System DO > Asthma Clinical Features in Adults 2 > Flashcards

Asthma Clinical Features in Adults 2 Flashcards

1
Q

What can a spirometer be used to measure

A

How much air can be expelled

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2
Q

Are the spirometery results reproduceable

A

Yes

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3
Q

Will a spirometer exclude asthma

A

No

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4
Q

What do FEV1 levels measure

A

Airway diameter

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5
Q

What does the FVC measure

A

Lung volume and can identify changes in lung tissue

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6
Q

What are the FEV1 and FVC levels like in asthma

A

Normal

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7
Q

What should be done if spirometery is normal

A

Peak flow monitoring

Bronchial provocation with nitric oxide

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8
Q

What should be done if the spirometery shows obstructed disease

A

Full pulmonary function test

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9
Q

How can the reversibility of an obstructed disease be tested

A

Through the use of a beta 2 agonist or steriods

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10
Q

What does it mean if the FEV1/FVC is below 70% and FEV1 is below 80% predicted

A

Obstructed disease

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11
Q

What will the full pulmonary testing effectively exclude

A

COPD

Emphysema

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12
Q

What does gas trapping measure and what is used

A

Helium dilution to measure lung volumes

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13
Q

What will the results of gas trapping show in obstructed disease

A

The residual volume increases
The total lung capacity increases
RV/TLC is over 30%

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14
Q

Will gas transfer be normal or abnormal in asthma

A

Normal

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15
Q

How can gas transfer be measured

A

Carbon monoxide gas transfer

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16
Q

What to tests are used in full pulmonary function testing

A

Gas trapping

Gas transfer

17
Q

When should the response to the bronchodilator be at the baseline

A

15 minutes post 400 microgram inhaled salbutamol

15 minutes post nebuliser 2.5-5mg salbutamol

18
Q

Which results show that significant reversibility is possible

A

If delta-FEV1 is over 200ml and delta-FEV1 is over 15% of the baseline

19
Q

When is the use of oral corticosteriods useful

A

In obstructed disease - it will help determine reversibility and variability

20
Q

What 2 diseases can oral corticosteriods seperate

A

COPD from asthma

21
Q

Why should the variability in airflow obstruction be looked for in asthmatic patients

A

Their lung function may be normal in clinic

22
Q

How can the variability in airflow obstruction be identified

A

Through the use of a peak flow meter and chart twice daily for 2 weeks

23
Q

What may the results of a peak flow meter for asthmatic patients show

A

Morning/nocturnal dips
Decline over weeks/days
Variability over 20% ([highest-lowest]/highest)

24
Q

What 2 things can cause occupational asthma to be suspected

A

Work related symptoms

Working with recognised sensitisers

25
Q

How is occupational asthma diagnosed

A

From serial peak flow readings that are done every 2 hours for a minimum of 5 days
Must be at least 2 pairs of exposed/unexposed periods
Antibodies and bronchial challenges can also confirm this

26
Q

Name an optional investigation which can be conducted

A

Testing of the airway responsiveness to methacholine/histamine/mannitol/exercise

27
Q

What other tests can be useful in identifying asthma

A

Chest X-ray - may show hyperinflation and hyperlucent
Skin prick testing - identifies atopic status
Total and specific IgE - identifies atopic status
Full blood count - may show eosinophilia (atopy)

28
Q

What are the 5 main things that should be tested in life threatening asthma

A 
Ability to speak
Heart rate
Respiratory rate
PEF
Oxygen saturation/Arterial blood gases
29
Q

Should a pulsus paradoxus be conducted in life threatening asthma

A

No

30
Q

How will moderate asthma present

A 
Able to speak complete sentences
HR <110
RR <25
PEF 50 - 75% predicted or best
SaO2 > 92% (no need for ABG)
PaO2 > 8kPa
31
Q

How will severe asthma present

A 
Unable to speak, unable to complete sentences 
HR >110
RR >25
PEF  33 - 50% predicted or best
SaO2 > 92% 
PaO2 > 8kPa
32
Q

How will life threatening asthma present

A 
Grunting
Impaired consciousness, confusion, exhaustion
HR >130, or bradycardic
Hypoventilating
PEF < 33% predicted or best
Cyanosis
SaO2 < 92% 
PaO2 < 8kPa
PaCO2 normal (4.6 - 6.0kPa)
33
Q

How will near fatal asthma present

A

Raised PaCO2

Respiratory System DO (33 decks)

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