asthma in adults

Question 1

asthma physiology of bronchioles

Answer 1

inflamed and thickened walls

Question 2

asthma attack physiology of bronchioles

Answer 2

inflamed and thickened walls

+

TIGHTENED SMOOTH MUSCLES

Question 3

whats atopy

Answer 3

body’s predisposition to develop an antibody called immunoglobulin E (IgE)

in response to exposure to environmental allergens and is an inheritable trait

Question 4

what is atopy associated with

Answer 4

allergic rhinitis, asthma, hay fever, and eczema

Question 5

what can Maternal smoking during pregnancy cause

Answer 5

decreased FEV1
^Wheezy illness
^Airway responsiveness
^Asthma

Question 6

other causes of wheeze, cough & dyspnoea

Answer 6

•Generalised airflow obstruction
COPD (irreversible AFO)
Bronchiectasis
Cystic Fibrosis

•Localised airway obstruction (inspiratory stridor= large airways)
Tumour
Foreign body

•Cardiac

Question 7

for diagnosis- if spirometry is normal whats done

Answer 7

Look for variability in airflow obstruction:

Peak flow meter & chart, twice daily (best of 3 measurements) for 2weeks

Question 8

signs of moderate acute asthma

Answer 8

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

Question 9

signs of severe acute asthma

Answer 9

• Inability to complete sentences in one breath
• HR ≥110
• RR ≥25
• PEF 33 -50% predicted or best
• SaO2≥ 92%
• PaO2≥ 8kPa

Question 10

signs of life threatening asthma

Answer 10

• Grunting
• Impaired consciousness, confusion, exhaustion
• Bradycardia/ arrhythmia/ hypotension
• PEF < 33% predicted or best
• Cyanosis
• Silent chest
• Poor respiratory effort
• SaO2< 92% (definitely needs blood gas!)
• PaO2< 8kPa
• PaCO2normal (4.6 -6.0kPa

Question 11

near fatal asthma

Answer 11

• Raised PaCO2

* Need for mechanical ventilation

Question 12

when are ICS started

Answer 12

Using SABA ≥3x a week
Symptomatic ≥3x a week
Waking one night a week
Asthma attack in the last two years