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Respiratory System > Asthma - COPIED > Flashcards

Asthma - COPIED Flashcards

1
Q

What is the treatment of acute asthma?

A
  • Oxygen (maintain 94-98%). Nebulisers should be driven by oxygen
  • Bronchodilator (Beta 2 agonists) by nebuliser every 15 mins, back to back if needed.
  • Steroids oral or IV and continue for 5 days
  • Consultants; ipratropium bromide neb (4-6 hrly), magnesium, aminophylline

NB> Salbutamol can be given IV if airway compromised.

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2
Q

When would you perform a ABG analysis?

A

When O2 sats are < 92%

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3
Q

Examination fo asthma (things to look for)

A
  • Abilty to speak
  • PEFR is vital to assess severity of attack. Work out % of predicted peak flow.
  • Rountine obs
  • ABCDE approach; A - airway. Can the patient talk?

B - breathing - inspection

C - circulation HR, BP, pulsus paradoxus

E - any rash/ hives to suggest allergic reaction. Exhaustion

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4
Q

Acute SEVERE asthma signs (any one of)

PEFR value?

Resp rate value?

HR value?

name one observation

A

PEFR 33-50% predicted

Resp rate >25/min

HR >110bpm

Inability to complete sentences in one breath

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5
Q

Why would you add a LABA?

A

If inhaled corticosteroid therapy is insufficient.

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6
Q

Name some triggers of asthma (8)

A
  • Gastro-oesophageal reflex esp at night
  • viral infections
  • cold
  • exercise
  • pollen
  • certain chemicals
  • animal dander
  • house mite dust
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7
Q

Why does gastroesophageal reflux disease (GORD) trigger an asthma attack?

A

If the stomach acid reaches into the throat or airways the
irritation and inflammation can trigger an asthma attack.

Often worse at night when lying down.

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8
Q

Can you gauge severity of attack by the wheeze?

WHY?

A

NO.

Severe attack… very reduced air flow (Silent chest)

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9
Q

If usual meds are ineffective for acute asthma attack, what is worth trying?

A

magnesium sulphate

2g over 20 minutes via 200ml saline (mark saline bag with time)

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10
Q

What is a common cause of asthma in childen under 10?

A

respiratory infection (viral or bacterial)

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11
Q

Does inflammation in the bronchioles during asthma result in increase in mucus production?

A

YES - hypersecretion of mucus from bronchial epithelium..

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12
Q

Why do you get chest tightness with asthma?

A

It is difficult to expire, and so air gets trapped in the lungs leading to chest. tightness.

This increase in air also increases resistance, resulting in difficulty breathing.

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13
Q

It’s not just histamine that creates an inflammatory response in the airways; what else?

A

Prostaglandins

Adenosine

Bradykinin

Major basic protein

Leukotrienes

Prostaglandins

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14
Q

What would you include in an assessment of asthma?

A
  • known triggers/ allergies
  • family history
  • medication
  • presenting symptoms
  • post history of astham management
  • Anything to suggest INFECTION?
  • Normal PEFR (if known)
  • other medical complaints
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15
Q

Why do 70% of asthma-related deaths occur at night?

A

circadian variation in bronchial responsiveness

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16
Q

Signs and symptoms of acute life-threatening asthma

(any ONE of the following)

A

Peak flow < 33% best or predicted
Arterial oxygen saturation (Sp02) < 92%
Partial arterial pressure of oxygen (PaO2) < 8 kPa
Normal partial arterial pressure of carbon dioxide (PaCo2) (4.6–6.0 kPa)
Silent chest
Cyanosis
Poor respiratory effort
Arrhythmia
Exhaustion
Altered conscious level

hypotension

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17
Q

Asthma affects boys or girls the most?

Asthma affects men or women the most?

A

BOYS

WOMEN

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18
Q

What is a big danger of late response asthma?

A
  • Increased airway resistance leads to air trapping in alveoli and hyperinflation of the lungs
  • If airway inflammation is not treated or does

not resolve, these reactions may lead to
irreversible lung damage

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19
Q

What are the clinical symptoms of asthma? ()

A
  1. Wheezing attacks
  2. episodic shortness of breath
  3. symptoms usually worse at night
  4. cough - nocturnal and often in children
  5. Diurnal variations in PEFR
  6. Revesible; 15% improvement if FEV1 after using a bronchodilator.
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20
Q

Describe the respiratory tract effect of anticholinergics (eg. ipratropium, tiotropium)

A

Helps prevent the bronchoconstriction of smooth muscle by inhibiting acetylcholine and the activation of parasympathetic n.s.

** they block the bronchoconstricting effect of the vagus (parasympathetic) nerve stimulation.

21
Q

Severe acute asthma attack.

any one of…

PFR?

Resp Rate?

HR?

general observation…

A

Any one of the following:

Peak flow 33–50% best or predicted

Respiratory rate ≥ 25/min

Heart rate ≥ 110/min

Inability to complete sentences in one breath

22
Q

What are the symptoms of acute asthma?

A
  • Feels like they can’t breathe
  • not enough air to cough
  • Can be gradual or rapid onset
  • anxiety
  • Feel unable to breathe out
  • (cough)
  • Wheezing
  • tight chest/ shortness of breath
23
Q

When would I refer a patient to ICU?

A
  • Failing to respond to therapy, worsening PEFR, worsening hypoxia, development of hypercapnia, exhaustion/ feeble respiration, confusion, respiratory arrest.
  • requiring ventilatory support
24
Q

Some cardinal symptoms of asthma (7)

A
  • Cough

Expiratory Wheeze

Breathlessness

Chest tightness

Nocturnal cough (especially children)

Exercise induced wheeze

Diurnal variation (worse at night and early morning)

25
Q

THREE pathogenetic process in asthma. Name them.

A
  1. bronchoconstriction
  2. swelling (and therefore narrowing of lumen) of epithelium
  3. hypersecretion of mucus (therefore << lumen)
26
Q

What is pulmonary consolidation?

Possible causes?

A

Alveolar space that contains liquid (could be oedema, blood, pus)

Pulmonary oedema

inflammation

pneumonia

pulmonary haemorrhaging

27
Q

What is different about the management of children with acute asthma?

A
  • Life-threatening if O2 Sata below 94%
  • use spacers
  • can add ipratropium to Salbutamol neb
28
Q

What’s the management for mild, persistent asthma?

A

Corticosteroid inhaler - preventer

Short acting B2 agonist as and when required.

29
Q

What causes the airways to become constricted?

A
  • constriction of the smooth muscle in the bronchioles
  • inflammed/ thickened epithelium
  • mucous production blocking the airways
30
Q

What lab investigations could be performed for acute asthma attack?

A
  • Sats - maintain between 94-98%
  • ABG if SpO2 <92%
  • CXR is NOT routinely recommended unless; suspected infection, pneumothorax, life-threatening asthma, failure to respond to tx.
31
Q

What’s the main marker for near fatal asthma? (2)

A

Raised PaCO2

Requiring mechanical ventilation with increased inflation pressures.

32
Q

Life-threatening asthma - possible signs (10), only one needed

A

PEFR <33% of predicted best

Sats <92%

PaO2 <8kPa, normal PaCO2 (4.6-6kPa)

Silent chest, cyanosis

arrthymia

altered mental state/ exhaustion

hypotension

33
Q

Definition of Asthma

A

Disease characterized by recurrent attacks of breathlessness and wheezing, which varies in frequency from person to person.

34
Q

With asthma, what should the O2 Sats percentage be maintained at?

A

between 94-98%

35
Q

What are the features of well-controlled asthma?

A

minimal symptoms at day and night

minimal need for reliever medication

no exacerbations

no limitation of physical activity

normal lung function PEFR >80% predicted/ best

36
Q

What is the pathophysiology of asthma? (3)

A

Bronchospasm

mucosal oedema

mucus hypersecretion

  • causing airway obstruction
37
Q

which is the steriod given IV for severe asthma?

A

prednisolone

40–50 mg daily for at least 5 days.

38
Q

what are the local effects of inhaled steroids?

A

Oral thrush

Sore mouth

Hoarse voice

39
Q

Which inhaled steroids can be given for asthma?

A

Beclometasone

Budesonide

Fluticasone (more potent, and given at half dose compared to the above)

NB. Budesonide is a dry powder inhaler.

40
Q

Why must LABAs be taken with steroids?

A

>> risk of death. Mechanism unknown.

Suggested that LABAs reduce the sensitivity of B2-receptors, making short-acting B2-agonists less effective during an acute attack.

41
Q

Salbutamol and Terbutaline are examples of?

A

short-acting B2-agonists, and have a biological half-life of 2-3 hours.

42
Q

What are Salmeterol and Formoterol examples of?

A

Long-acting B2 agonists. Half-life 15 hours.

43
Q

What are the side effects of B2-adenoceptor agonists?

A

Tremor, tachycardia,

anxiety, hypokalaemia.

44
Q

When is it appropriate to use montelukast or zafirlukast?

(leukotriene receptor antagonists)

A

Step 3 or 4 chronic asthma.

Exercise and aspirin-induced asthma.

Patients with associated rhinitis and/or nasal polyps.

NB. Taken orally OD

45
Q

What’s the difference between intrinsic and extrinsic asthma?

A

Intrinsic; childhood and adolescent onset, atopic and and driven by allergen exposure.

Extrinsic; late-onset with adults,often following viral URTI.

46
Q

How does airflow inflammation seen in asthma lead to airflow obstruction?

A

mast cell degranulation releases histamine, prostaglandins, and leukotrienes.

This causes; vasodilatation and increased vascular permability causing mucosal oedema.

Increase in bronchial secretions.

Smooth muscle contraction, causing bronchospasm.

47
Q

What changes occur with chronic asthma?

A

>> goblet cells (increase mucus).

thickening of basement membrane.

Smooth muscle hyperplasia and hypertrophy.

48
Q

Why is asthma worse at night?

A
  • Impaired mucoclilary clearance during sleep.
  • Possible increase exposure to allergens (house dust mite in bedding).
  • Diurnal fluatuations in corticosteroids, catecholamines.
49
Q

Mx of acute asthma attack key points

A

Give oxygen to maintain 94-98% sats

Salbutamol, back to back if needed. Oxygen driven if needed.

Oral prednisolone 45-50mg for five days.

Combine ipratropium with salbutamol if poor response.

Consultant; magnesium/ aminophylline

Respiratory System (7 decks)

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