Asthma Clinical Features in Adults Flashcards
What is asthma
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
Describe the pathophysiology of asthma
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
What percentage of children are affected with asthma
10-15%
More males have the conditon
What percentage of adults are affected with asthma
5-10%
More females have the condition
How many people are currently receiving treatment for asthma
5.4 million
How many children are currently receiving treatment for asthma
1.1 million
How many adults are currently receiving treatment for asthma
4.3 million
How many death per annum are due to asthma
1000
Mainly over 60’s and smokers
How many hospital admissions were there in the UK
67,000
How much does the NHS spend every year on asthma
£889 million
How much other costs are spent every year on asthma
£1,460 million
How much is spent overall on asthma every year
£2,349 million
What areas of the NHS do these costs come from
Medication
Dispensing
In-patient activity
Primary care activity
What type of other costs are there
Loss of productivity
Benefits
What are the 3 main proven risk factors for asthma
Genetics
Occupation
Smoking
What is atopy
The inherited tendency to an IgE response to allergens
What type of genetic factors are there (3)
Personal
Famillial atopic tendency
Maternal atopy (3x more influential than paternal)
Name the two genetic associations
Immune response genes (IL-4, IL-5 and IgE) Airway genes (ADAM33)
What percentage of adult onset asthma is due to their occupation
10-15%
What type of occupational interactions can lead to adult onset asthma
Interactions with:
Smoking
Atopy
Give examples of occupational atopies
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
What can maternal smoking during pregnancy cause
Reduced FEV1
Increased wheezy illness
Increased airway responsiveness
Increased asthma with increased severity
In what conditions does the house dust might thrive
Humid houses
Where is the house dust mite common
Across Europe
Coastal Australia
What allergen is present in the house dust mite droppings
Protease
How are humans exposed to the house dust mite allergens
Through pillows/beds
What does the cat provide
Universal exposure to allergens with evidence to show that the exposure may be protective
When does the universal exposure to cat allergens become a problem
When a person becomes sensitised
Does exposure to allergens initiate or cause atopy/asthma
No
What do the factors associated with affluence increase
The likelihood of sensitisation to local allergens
Give examples of generalised airflow obstructions
Asthma (reversible AFO) COPD (irreversible AFO) Bronchiectasis Bronchiolitis Cystic Fibrosis
What are the symptoms of asthma
Wheeze Short of breath (dyspnoea), severity Chest tightness (pain) Paroxysmal (sudden reoccurrence of symptoms) cough, usually dry Sputum (occasional)
When trying to diagnose asthma what do we need to do
We need to differentiate from the other causes of the symptoms of asthma (wheeze, cough and asthma)
When could inspiratory stridor be seen
In tumours and presence of foreign bodies
What are the three categories a patient can be placed into when considering asthma
High probability of asthma
Intermediate probability of asthma
Low probability of asthma
Name some triggers of asthma
Exercise Cold air Smoke Perfume URTI’s Pets Tree Grass pollen Food Aspirin
What type of spontaneous variation can the symptoms of asthma have
Daily
Weekly
Annual
When do the daily variations present
Early morning
Nocturnal
When would the weekly variations occur
At the patients workplace
Would get better when away from work and on holidays
What could the annual variations be due to
Environmental variations
What are some important past medical history factors
Childhood asthma
Bronchitis
Eczema
Hayfever
What are some important medications which the patient could be using
Current inhalers (doseage in g NOT puffs, technique should be checked and compliance asked)
Beta-blockers
Aspirin
NSAIDS
What else should a patient be asked in regards to medications
The effects of previous drugs and inhalers
In regards to family medical history what should be asked
Atopic disease in the immediate family (mother, father, brother and sister)
Name some important aspects of a patients social history in regards to asthma
Smoking
Pets
Occupations past/present (what the job entails)
Psychosocial aspects
What type of psyschosocial aspects can make asthma worse
Stress and strains of life
Name three things which can be examined in clinic that are unhelpful
Breathlessness on exertion
Hyperexpanded chest
Polyphonic wheezes
Name 5 things which if examined indicated that it is not asthma
Clubbing, cervical lymphadenopathy
Stridor
Assymetrical expansion
Dull percussion note, (lobar collapse, effusion)
Crepitations (bronchiectasis, CF, alveolitis, LVF)
When do investigations tend to be undertaken
If there is an intermediate probability of asthma
What do the investigations tend to involve
Looking for evidence of airflow obstructions
Looking for the variability and/or reversibility of the airflow obstruction
Spirometery
