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Respiratory System DO > Asthma Clinical Features in Adults > Flashcards

Asthma Clinical Features in Adults Flashcards

1
Q

What is asthma

A

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

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2
Q

Describe the pathophysiology of asthma

A

Inflammation of the airway mediated by the immune system
This can either cause the widespread narrowing of the airways or increased airway reactivity
Increased reactivity of the airway causes the airway to narrow either spontaneously or due to a stimulus

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3
Q

What percentage of children are affected with asthma

A

10-15%

More males have the conditon

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4
Q

What percentage of adults are affected with asthma

A

5-10%

More females have the condition

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5
Q

How many people are currently receiving treatment for asthma

A

5.4 million

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6
Q

How many children are currently receiving treatment for asthma

A

1.1 million

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7
Q

How many adults are currently receiving treatment for asthma

A

4.3 million

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8
Q

How many death per annum are due to asthma

A

1000

Mainly over 60’s and smokers

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9
Q

How many hospital admissions were there in the UK

A

67,000

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10
Q

How much does the NHS spend every year on asthma

A

£889 million

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11
Q

How much other costs are spent every year on asthma

A

£1,460 million

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12
Q

How much is spent overall on asthma every year

A

£2,349 million

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13
Q

What areas of the NHS do these costs come from

A

Medication
Dispensing
In-patient activity
Primary care activity

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14
Q

What type of other costs are there

A

Loss of productivity

Benefits

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15
Q

What are the 3 main proven risk factors for asthma

A

Genetics
Occupation
Smoking

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16
Q

What is atopy

A

The inherited tendency to an IgE response to allergens

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17
Q

What type of genetic factors are there (3)

A

Personal
Famillial atopic tendency
Maternal atopy (3x more influential than paternal)

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18
Q

Name the two genetic associations

A 
Immune response genes (IL-4, IL-5 and IgE)
Airway genes (ADAM33)
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19
Q

What percentage of adult onset asthma is due to their occupation

A

10-15%

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20
Q

What type of occupational interactions can lead to adult onset asthma

A

Interactions with:
Smoking
Atopy

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21
Q

Give examples of occupational atopies

A 
Isocyanates - twin pack paints
Colophony - welding solder flux
Laboratory animals’ -
 rodent urinary proteins
Grains - wheat proteins, grain mites
Enzymes - subtilisin, amylase
Drugs - antibiotics, salbutamol
Crustaceans - prawns, crabs
22
Q

What can maternal smoking during pregnancy cause

A

Reduced FEV1
Increased wheezy illness
Increased airway responsiveness
Increased asthma with increased severity

23
Q

In what conditions does the house dust might thrive

A

Humid houses

24
Q

Where is the house dust mite common

A

Across Europe

Coastal Australia

25
Q

What allergen is present in the house dust mite droppings

A

Protease

26
Q

How are humans exposed to the house dust mite allergens

A

Through pillows/beds

27
Q

What does the cat provide

A

Universal exposure to allergens with evidence to show that the exposure may be protective

28
Q

When does the universal exposure to cat allergens become a problem

A

When a person becomes sensitised

29
Q

Does exposure to allergens initiate or cause atopy/asthma

A

No

30
Q

What do the factors associated with affluence increase

A

The likelihood of sensitisation to local allergens

31
Q

Give examples of generalised airflow obstructions

A 
Asthma (reversible AFO)
COPD (irreversible AFO)
Bronchiectasis
Bronchiolitis
Cystic Fibrosis
32
Q

What are the symptoms of asthma

A 
Wheeze
Short of breath (dyspnoea), severity
Chest tightness (pain)
Paroxysmal (sudden reoccurrence of symptoms) cough, usually dry
Sputum (occasional)
33
Q

When trying to diagnose asthma what do we need to do

A

We need to differentiate from the other causes of the symptoms of asthma (wheeze, cough and asthma)

34
Q

When could inspiratory stridor be seen

A

In tumours and presence of foreign bodies

35
Q

What are the three categories a patient can be placed into when considering asthma

A

High probability of asthma
Intermediate probability of asthma
Low probability of asthma

36
Q

Name some triggers of asthma

A 
Exercise	
Cold air
Smoke
Perfume
URTI’s
Pets
Tree
Grass pollen
Food
Aspirin
37
Q

What type of spontaneous variation can the symptoms of asthma have

A

Daily
Weekly
Annual

38
Q

When do the daily variations present

A

Early morning

Nocturnal

39
Q

When would the weekly variations occur

A

At the patients workplace

Would get better when away from work and on holidays

40
Q

What could the annual variations be due to

A

Environmental variations

41
Q

What are some important past medical history factors

A

Childhood asthma
Bronchitis
Eczema
Hayfever

42
Q

What are some important medications which the patient could be using

A

Current inhalers (doseage in g NOT puffs, technique should be checked and compliance asked)
Beta-blockers
Aspirin
NSAIDS

43
Q

What else should a patient be asked in regards to medications

A

The effects of previous drugs and inhalers

44
Q

In regards to family medical history what should be asked

A

Atopic disease in the immediate family (mother, father, brother and sister)

45
Q

Name some important aspects of a patients social history in regards to asthma

A

Smoking
Pets
Occupations past/present (what the job entails)
Psychosocial aspects

46
Q

What type of psyschosocial aspects can make asthma worse

A

Stress and strains of life

47
Q

Name three things which can be examined in clinic that are unhelpful

A

Breathlessness on exertion
Hyperexpanded chest
Polyphonic wheezes

48
Q

Name 5 things which if examined indicated that it is not asthma

A

Clubbing, cervical lymphadenopathy
Stridor
Assymetrical expansion
Dull percussion note, (lobar collapse, effusion)
Crepitations (bronchiectasis, CF, alveolitis, LVF)

49
Q

When do investigations tend to be undertaken

A

If there is an intermediate probability of asthma

50
Q

What do the investigations tend to involve

A

Looking for evidence of airflow obstructions
Looking for the variability and/or reversibility of the airflow obstruction
Spirometery

Respiratory System DO (33 decks)

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