Asthma in Adults Flashcards
What is the prevalence of asthma in adults?
Less than children (5-10%).
Affects more females than males.
What is the genetic basis of asthma?
The disease clusters in families - risk increases if a first degree family member has asthma (or another atopic disease).
Maternal atopy is most influential; grandmothers also increase risk.
What is atopy?
The body’s predisposition to develop IgE antibodies in response to exposure to environmental allergens; an inheritable trait.
What can maternal smoking during pregnancy cause?
A decrease in FEV1.
An increase in wheezy illness, airway responsiveness and asthma.
What is occupational asthma?
Caused by interactions with smoking and atopy.
Jobs involving paint, animals, grains, drugs, crustaceans, welding, etc.
What is associated to increasing the likelihood of getting asthma?
Increased BMI.
A fatty diet.
Reduced exposure to microbes.
What are the main symptoms of asthma?
A wheeze.
SOB.
Chest tightness.
A dry cough.
Sputum (occasionally).
How are asthma symptoms variable?
Daily - morning and night.
Weekly - occupation, weekends, holidays.
Annual - environmental.
What are some common asthma triggers?
Exercise.
Cold air.
Cigarette smoke.
Perfumes.
URTIs.
Pets.
Pollen.
Food.
Drugs.
What are some important aspects of taking a history for an asthmatic patient?
PMH -
Childhood asthma, eczema, hayfever.
DH -
Current inhalers (check technique), other asthma therapies, compliance.
Beta blockers, aspirin, NSAIDs.
Effects of previous drugs / inhalers.
FH -
Asthma, other atopic diseases.
SH -
Occupation (past and present).
Psychological aspects.
Pets.
Tobacco / recreational drugs / vaping.
How can a clinical examination help diagnose asthma?
Usually unhelpful.
Breathless on exertion, hyperinflated chest, wheeze.
What symptoms show it is likely not asthma?
Finger clubbing - cervical lymphadenopathy.
Stridor.
Asymmetrical expansion, dull percussion note - collapsed lung or pleural effusion.
Crepitations - bronchiectasis, CF, ILD, LVF.
What are some differential diagnoses for asthma?
Generalised airflow obstruction - COPD, bronchiectasis, CF.
Localised airflow obstruction - tumours, foreign bodies.
Cardiac - heart failure, valvular heart disease.
What is investigated in patients with an intermediate probability and history of asthma?
Evidence of airflow obstruction.
Variability and/or reversibility of airflow obstruction.
What tests are done for asthma?
If FEV1/FVC is lower than normal -
Full pulmonary function tests, reversibility tests.
If FEV1/FVC is normal -
Variability of airflow obstruction.
