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Asthma > Asthma Ghanaian Guideline > Flashcards

Asthma Ghanaian Guideline Flashcards

1
Q

Asthma is defined by GINA as

A

Heterogenous disease characterized by chronic inflammation

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2
Q

The chronic airway inflammation in asthma is associated with

A

Airway hyper-responsiveness that leads to recurrent episodes of wheeze , difficulty in breathing, chest tightness and cough

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3
Q

Asthma is associated with reversible

A

Airway obstruction that could resolve Spontaneously or with treatment

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4
Q

Asthma related mortality occurs more frequently in

A

Adults compared to children per WHO report in 2020

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5
Q

Factors associated with asthma deaths are

A

Previous admission to intensive care unit

# Severe asthma necessitating chronic oral corticosteroids
#Poor daily asthma symptom control with excessive use of SABA (1.4 canisters per month)
#Abnormal forced expiratory volume in 1 second (FEV1)
#Frequent emergency department visits
#Low socioeconomic status
#Family dysfunction
#Patient psychological problems

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6
Q

Asthma is the result of

A

An interplay between genetic and environmental factors

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7
Q

Atopy is a genetic tendency to

A

Develop allergic conditions in response to common environmental allergens

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8
Q

The strongest risk factor for the development of asthma

A

Atopy

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9
Q

Airway hyper-responsiveness is defined as

A

Excessive reactivity or narrowing of the airway in response to broncho-constrictive

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10
Q

Which other genetic aetiology is closely related to atopy

A

Airway hyper-responsiveness

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11
Q

Examples of environmental factors include

A

Indoor allergens ( house dust mites, cockroaches)

#Air pollutants
#Respiratory viruses
#Diet
#Endotoxins
#Seasonal outdoor allergens ( grass, pollens ,molds, animal dander )

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12
Q

Patients with atopic /allergic asthma tend to have positive family history of allergic diseases such as

A

A)Rhinitis
Eczema
Urticarial

B)And develop asthma in early childhood

C) They are more likely to have peripheral eosinophilia or raised serum IgE levels

D) Positive skin prick test to intradermal injection of allergens

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13
Q

The non-atopic/ non- allergic asthma symptoms are triggered by non allergic factors such as

A

Stress
Cold
Dry air
Anxiety
Viruses

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14
Q

In adults, occupational exposures to organic and inorganic chemicals could lead to

A

Development of occupational asthma

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15
Q

In childhood, there is a male preponderance of asthma, as well as asthma related hospital admissions in the pre-pubertal ages . However, after puberty, asthma is more prevalent and severe in

A

Females and this has been associated with hormonal changes and gender specific environmental exposures

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16
Q

Role of diet in the aetiology of Asthma

A

Low intake of
# fruits and vegetables
# Dairy fats
#Vitamin C
#Vitamin E

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17
Q

Although not scientifically substantiated , it is believed that infants with shorter periods of breastfeeding (less than 6 months) have

A

Increased risk of developing asthma

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18
Q

What has been shown to be a risk factor as well as a disease modifier for asthma in both children and adults based on longitudinal studies

A

Obesity

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19
Q

Weight gain in pregnancy could be associated with

A

15-30% risk of child developing asthma

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20
Q

According to the hygiene hypothesis, exposure to some germs and bacterial endotoxins helps

A

Mature the young child’s immune response this protecting against asthma and other allergic diseases

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21
Q

The hygienes hypothesis is supported by

A

Longitudinal
Epidemiological studies

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22
Q

The hygiene hypothesis explain the

A

Increased prevalence of asthma in urban dwellings compared to rural settings

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23
Q

Children with asthma from lower socioeconomic backgrounds are at increased risk of being exposed to

A

Indoor( house dust mite, cockroaches)
Outdoor(biomass fuel, urban pollution) allergens due to poor housing conditions which could exacerbate background asthma symptoms

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24
Q

Exposure to environmental tobacco smoking increases the risk of

A

Childhood Asthma

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25
Q

Cardinal features which contribute to the pathophysiology of asthma are

A

Airway inflammation

#Airway hyper-responsiveness
#Bronchial smooth muscle constriction
#Increased mucus production
#Bronchial airway remodeling

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26
Q

Airway inflammation involves inflammatory cells such as eosinophils and mast cells which

A

Release mediators of inflammation

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27
Q

The mediators of inflammation in asthma

A

Induce goblet cells in the airway mucous membrane to produce mucus

#Induce airway smooth muscle contraction leading to narrowing of the airway
# The airway inflammation also leads to bronchial hyper-responsiveness which make people with asthma vulnerable to environmental triggers

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28
Q

Two main pathways in the pathophysiology of asthma

A

Immunologic( allergic/atopic) pathway

#Non-immunologic (non-allergic /non-atopic) pathway

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29
Q

Patients with atopic asthma phenotype are likely to have

A

T helper 2 lymphocytes and IgE mediated immune response to allergens leading to an exaggerated production of inflammatory mediators

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30
Q

The immunologic response is characterized by

A

Acute(immediate) and late phase reactions with the late phase responsible for the chronic and persistent effect of allergic inflammation

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31
Q

Clinical features of Asthma

A

Recurrent symptoms of
#Wheeze
#Cough
#Shortness of breath
#Chest tightness which vary over time and intensity

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32
Q

Cough variant Asthma

A

Wheeze is present with recurrent cough

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33
Q

Clinical features that reduce likelihood of asthma and suggest alternative diagnosis

A

Chronic cough with no associated wheezing or breathlessness

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34
Q

Transient Wheeze

A

Wheezing episodes which begin in the first three years of life and may be associated with respiratory tract infections but cease by age six

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35
Q

Persistent wheeze is

A

Wheezing that begins in the first three years of life and persist beyond six years

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36
Q

Late onset wheeze is

A

Wheezing episodes that begin after age six

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37
Q

Episodic Viral Wheeze is wheezing

A

High usually occurs in association with a common cold. There is no wheeze outside episodes of the upper respiratory tract infections

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38
Q

Features suggestive of asthma in pre-school children

A

Pattern - episodic pattern together with other respiratory symptoms

# Reversibility

#

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39
Q

Investigations for asthma appropriate for pre-school children

A

Modified bronchodilator response test

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40
Q

Investigations for asthma appropriate for pre-school children

A

Modified bronchodilator response test

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41
Q

Investigations for asthma appropriate for pre school children

A

Modified bronchodilator response test

#Allergy test( Skin prick test can be performed in children over age three)
#Plain chest X ray

NB: a positive skin prick test will support underlying atopy . However , a negative test does not rule out asthma

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42
Q

Investigations performed to diagnose asthma in adults and children six years and older

A

Pulmonary Function Tests

#Bronchial challenge Test ( Bronchoprovocative test)
#Fractional exhaled nitric oxide
# Other supporting investigations that may help in the diagnosis of asthma like blood and sputum eosinophil count

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43
Q

The ratio of FEV1 over FVC indicates airway obstruction if it is

A

Less than 0.7 in an adult or less than 0.9 in a child 6 years and over

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44
Q

The ratio of FEV1 and forced vital capacity (FVC) indicates airway obstruction if it is

A

Less than 0.7 in an adult or less than 0.9 in a child 6 years and over

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45
Q

The goal of Pulmonary Function Test in asthma diagnosis is

A

Document reversible expiratory airflow limitation or obstruction. This is done with Spirometry and Peak Expiratory Flow Rate measurement

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46
Q

Spirometry is more accurate and gives reproducible results than the PEFR and is preferred for the

A

Diagnosis of Asthma

47
Q

Pulmonary Function Test is performed in what age group

A

6 years and above

48
Q

Normal spirometry result(> 0.70-0.80 in healthy adults and > 90 in children) does not exclude the diagnosis of asthma as patients may be

A

Asymptomatic during the period of testing

49
Q

Reversibility in airflow obstruction is confirmed when there is an increase in

A

Baseline FEV1 greater than 12% and/ or 200ml after administration of 200 to 400 micrograms of inhaled salbutamol. Reversibility is confirmed using a peak expiratory flow meter when baseline PEFR measurements increases by more than 20% after inhalation of 200-400 micrograms of salbutamol or after a 2 week course of oral prednisolone

50
Q

Bronchial challenge test is performed in adults only where a fall in FEV1 from baseline of greater or equal to

A

20% after nebulization with standard incremental doses of methacholine or histamine is confirmatory of asthma

51
Q

Fractional exhaled nitric oxide measurement is used in diagnosis of asthma when

A

Spirometry is inconclusive

52
Q

Fractional exhaled nitric oxide level of

A

40 parts per billion or more is regarded as suggestive of asthma in adults while in children while a value of 35ppb or more suggestive of asthma

53
Q

Blood eosinophilia greater than 4% or 300-400/microliter or sputum eosinophil> 3% supports diagnosis of

A

Asthma

54
Q

Occupational Asthma is caused by workplace exposure to

A

Allergic and non-allergic stimuli

55
Q

There are two main forms of Occupational Asthma

A

Sensitizer induced

#Irritant induced

56
Q

Sensitizer induced Asthma is caused by

A

Allergic stimuli and develops after a latency period between the first exposure and the onset of symptoms . Results from exposure to a substance that the workplace

57
Q

Irritant induced Occupational Asthma

A

Caused by exposure to non-allergic irritants at the work place

58
Q

Uncontrolled Asthma is usually due to

A

Lapses in quality of care

#Inadequate use of steroids
#Reliance on bronchodilators

59
Q

Good control of symptoms means a patient

A

Experiences no more than 1 daytime symptom per month

#Has no acute exacerbations in the past month
#Has no night time symptoms which interfere with sleep being able to participate in daily activities including physical exercise and sports

60
Q

What medication is given to reduce the risk of serious exacerbations

A

Inhaled ICS

61
Q

According to GINA, what medication is given as reliever therapy

A

ICS Formoterol or SABA+ ICS

62
Q

SABA only treatment is not recommended by GINA as

A

It increases the risk of exacerbations and that adding any ICS significantly reduces the risk

63
Q

Treatment with LABA only is not

A

Recommended

64
Q

Budesonide Formoterol is prescribed as

A

Reliever therapy
Maintenance therapy or
As needed only

65
Q

Maximum recommended total dose of Formoterol Budesonide is

A

54mcg of Formoterol (12 inhalations of budesonide Formoterol)

66
Q

Beclomethasone Formoterol is prescribed in

A

Maintenance therapy
Reliever therapy

67
Q

The maximum recommended total dose of Beclomethasone Formoterol in one day is

A

36mcg Formoterol (8 inhalations of Beclomethasone Formoterol)

68
Q

Fluticasone salmeterol is not recommended for maintenance and reliever therapy due to

A

Slower onset of action of salmeterol than Formoterol

69
Q

According to GINA, How many steps are there in asthma therapy

A

5 steps

70
Q

According to GINA, how many tracks are there

A

2
Preferred Track
Alternative Track

71
Q

Step 1 approach to Asthma therapy in GINA is for when

A

Symptom less than twice a month

72
Q

Controller in the preferred track for step 1 in GINA is

A

As needed low dose ICS Formoterol

73
Q

Step 2 approach to Asthma therapy in GINA is for

A

Symptom twice a month or more but less than 4-5 days a week

74
Q

Controller in Preferred track for step 2

A

As needed low dose ICS Formoterol

75
Q

Step 3 approach in GINA is for

A

Symptoms most days or waking with asthma

76
Q

Controller for step 3 in preferred track is

A

Daily low dose ICS Formoterol

77
Q

Step 4 approach in GINA is for

A

Daily symptoms or waking with asthma once a week or more and low lung function

78
Q

Controller for step 4 in preferred track is

A

Daily medium dose ICS Formoterol

79
Q

Controller in step 5 is

A

Refer to a pulmonologist or specialist
High dose ICS LABA
LAMA may be added on

80
Q

Add on therapy for preferred track is

A

Leukotriene antagonists
Montelukast
Pranlukast
Zafirlukast

81
Q

Benefits of Leukotriene antagonists

A

Additional bronchodilator effect

#Improve Lung function
#Reduce cough
#Airway inflammation
#Acute exacerbation
#Reduce symptoms of allergic comorbidities

82
Q

Leukotriene antagonists are rarely associated with

A

Neuropsychiatric side effects especially in children such as hallucinations, hence should be used with caution

83
Q

Controller used in step 1 for alternative track is

A

ICS + SABA as needed

84
Q

Controller used in step 2 for alternative track is

A

Daily low dose ICS

85
Q

Controller used in step 3 for alternative track is

A

Daily low dose ICS LABA

86
Q

Controller used in step 4 for alternative track is

A

Daily medium /high dose maintenance ICS-LABA

87
Q

Add on therapy in alternative track starting at step 2 upwards is

A

Leukotriene antagonists

88
Q

Reliever in preferred track is

A

As needed low dose ICS Formoterol

89
Q

Reliever in Alternative track is

A

As needed SABA

90
Q

Anti-immunoglobulin E (e.g Omalizumab ) may be used in patients with

A

Severe persistent allergic asthma who are receiving oral corticosteroids and moderate to high dose ICS/LABA.

91
Q

How is Omalizumab given

A

Subcutaneous injection every 2 -4 weeks and the dosage depends on serum IgE and patient’s weight.
It may be used in patients who are >= 6 years old.

92
Q

Reliever in children less than 6 years is

A

SABA because Steroids are avoided due to side effects

93
Q

Controller medication used in children 11 years and below is

A

ICS alone in < 6 years
> 6 years ICS alone or ICS LABA

94
Q

Role is written asthma action plan

A

To help the patient become more involved in their management, recognize symptoms early and respond appropriately

95
Q

Asthma action plan is a w written individualized worksheet that

A

Shows an individual with asthma the steps to take to keep the condition from getting worse

96
Q

Acute asthma exacerbations are episodes of

A

Worsening symptoms (shortness of breath, wheezing,chest tightness and cough) and or decline in lung function compared to an individual’s usual status that is often sufficient to warrant a change in treatment of the patient

97
Q

Asthma exacerbation may also be known as

A

Flare-up
Asthma attack
Acute asthma

98
Q

Asthma exacerbation is marked by the

A

Onset of acute airway inflammation when a patient is exposed to a trigger or may represent worsening of chromic airway inflammation

99
Q

In asthma exacerbation, we give oxygen if SPO2 is below

A

94%

100
Q

After giving oxygen in acute exacerbation in asthma, what is given next

A

SABA by MDI or nebulization depending on severity

#Consider Ipratropium bromide in those not responding to SABA alone
#Give corticosteroids within 1 hour

101
Q

Bronchodilators are administered at intervals of

A

20 minutes for up to 1 hour initially until the patient has adequate response in asthma exacerbation

102
Q

Dose of IV magnesium sulphate is

A

1.2-2g slowly over 20 minutes (25-50mg/kg, maximum 2g in children)

103
Q

Recommended dose of IV Aminophylline is

A

5mg/kg as a bolus over 5 minutes followed with infusion given per kg body weight

104
Q

IV Aminophylline should be used with caution and

A

Patient’s pulse and or electrocardiogram must be monitored for possible arrhythmias

105
Q

IV salbutamol and adrenaline (SC or IV) may be used in

A

Severe asthma under specialist care

106
Q

Corticosteroids used in asthma emergency

A

Oral Prednisolone
IV hydrocortisone

107
Q

Oral Prednisolone is preferred to IV hydrocortisone because

A

Longer duration of action
Oral route of administration is easier

108
Q

IV hydrocortisone is administered to patients who are unable to take oral Prednisolone for reasons like

A

Vomiting
Impaired consciousness
Patient not wanting to take oral Prednisolone

109
Q

Side effects of steroids

A

Sleep disturbances

#Increased appetite
#Gastroesohageal reflux
#Mood changes

110
Q

Patient is discharged if

A

Symptoms improved and patient is stable for at least 4 hours after the last dose of SABA

#SPO2 > 94% on room air for at least 12 hours
#PEFR> 75% of personal best or predicted
#Good home support is assured

111
Q

Management of mild allergic rhinitis

A

Intranasal corticosteroid

112
Q

Management of moderate allergic rhinitis

A

Intranasal steroids
Nasal decongestants (nasal saline drops)
Oral antihistamine

113
Q

Severe allergic rhinitis

A

Combination therapy with
Inhaled steroids
Oral antihistamines
LTRA
Nasal decongestants

Asthma (1 decks)

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