Asthma (Obstructive Airway Disease) Flashcards
What is asthma?
It is an inflammatory disorder associated with recurrent and episodic airway obstruction, with associated chronic airway inflammation
What causes the symptoms of asthma?
Bronchoconstriction, which is a result of airway hyper-responsiveness to normally innocuous stimuli
What are some common triggers of asthma?
Allergy (atopic)
Exercise
Cold air
Environmental pollutants (e.g. Smoke)
Drugs (e.g. NSAIDS, B Blockers)
What occurs in the airway as a result of exposure to triggers?
Bronchoconstriction due to hyper reactivity, mucosal swelling / inflammation and increased mucous production due to mast cell degranulation and release of inflammatory mediators
What type of inflammation is associated with asthma?
Eosinophilic
What is the effect of eosinophilic inflammation in asthma?
Exacerbations of airway hyper responsiveness, which will increase frequency of symptoms and air remodeling inclusive of smooth muscle hypertrophy, collagen deposition and basement membrane thickening resulting in a fixed airway obstruction
What are the main symptoms of asthma?
Intermittent SOB, expiratory polyphonic wheeze, tight chest and dry or productive cough
What differentiates these symptoms in asthma from other respiratory diseases?
In asthma these symptoms may happen in a response to a specific trigger e.g. an allergen, exercise, show diurnal variation (be worse at night or early in the morning) or interrupt sleep
What investigations can be used to confirm a diagnosis of asthma?
PEFR, Spirometry, Bronchial challenge test and CXR
What PEFR results would be indicative of asthma?
Reduced
What spirometry results would be indicative of asthma?
Normal FVC, decreased FEV1 & FER > 75%
What bronchial challenge results would be indicative of asthma?
> 15% response to SABA
What CXR results would be indicative of asthma?
Hyperinflation
What lifestyle advice should be used in the management of asthma?
Trigger avoidance, smoking cessation
What pharmacological treatment should be used in the management of acute intermittent asthma?
Salbutamol PRN
When should a patient be moved to the chronic asthma management plan?
Asthma attack within 2 years, using reliever 3 or more times per week, symptomatic 3 or more times per week or waking up at night once per week
What are the two main parts of the chronic asthma management plan?
Education and Pharmacological treatments
What is covered in the ‘Education’ part of managing chronic asthma?
- Inhaler technique
- How to check peak flow / encourage to keep a diary
- Advice about when to use certain inhalers
- What one is a reliever/preventer
- When to use reliever
- When to seek help
What is step one of chronic asthma management?
Low dose Inhaled Corticosteroid (ICS) e.g. Beclometasone Dipropionate & Short Acting Beta Agonist (SABA) e.g. Salbutamol
What is step two of chronic asthma management?
Add a Long Acting Beta Agonist (LABA) e.g. Formetarol - usually this is prescribed in a combination inhaler e.g. Fostair or Relvar
What is step three of chronic asthma management?
Add a leukotriene receptor antagonist (LTRA) e.g. Montelukast 10mg OD. Alternatively, add Tiotropium or consider increasing ICS or If required, refer to specialist.
What is step four of chronic asthma management?
Add a steroid (e.g. Prednisolone) or consider increasing ICS and refer to a specialist
When do you step up the management plan?
If having to use SABA more than 3 times a week on top of current treatment
What are the indications of a moderate acute asthma attack?
Increasing symptoms, PEFR > 50 – 75% of best and no features of a severe acute attack
