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First Year > Asthma (Obstructive Airway Disease) > Flashcards

Asthma (Obstructive Airway Disease) Flashcards

1
Q

What is asthma?

A

It is an inflammatory disorder associated with recurrent and episodic airway obstruction, with associated chronic airway inflammation

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2
Q

What causes the symptoms of asthma?

A

Bronchoconstriction, which is a result of airway hyper-responsiveness to normally innocuous stimuli

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3
Q

What are some common triggers of asthma?

A

Allergy (atopic)
Exercise
Cold air
Environmental pollutants (e.g. Smoke)
Drugs (e.g. NSAIDS, B Blockers)

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4
Q

What occurs in the airway as a result of exposure to triggers?

A

Bronchoconstriction due to hyper reactivity, mucosal swelling / inflammation and increased mucous production due to mast cell degranulation and release of inflammatory mediators

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5
Q

What type of inflammation is associated with asthma?

A

Eosinophilic

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6
Q

What is the effect of eosinophilic inflammation in asthma?

A

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

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7
Q

What are the main symptoms of asthma?

A

Intermittent SOB, expiratory polyphonic wheeze, tight chest and dry or productive cough

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8
Q

What differentiates these symptoms in asthma from other respiratory diseases?

A

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

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9
Q

What investigations can be used to confirm a diagnosis of asthma?

A

PEFR, Spirometry, Bronchial challenge test and CXR

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10
Q

What PEFR results would be indicative of asthma?

A

Reduced

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11
Q

What spirometry results would be indicative of asthma?

A

Normal FVC, decreased FEV1 & FER > 75%

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12
Q

What bronchial challenge results would be indicative of asthma?

A

> 15% response to SABA

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13
Q

What CXR results would be indicative of asthma?

A

Hyperinflation

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14
Q

What lifestyle advice should be used in the management of asthma?

A

Trigger avoidance, smoking cessation

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15
Q

What pharmacological treatment should be used in the management of acute intermittent asthma?

A

Salbutamol PRN

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16
Q

When should a patient be moved to the chronic asthma management plan?

A

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

17
Q

What are the two main parts of the chronic asthma management plan?

A

Education and Pharmacological treatments

18
Q

What is covered in the ‘Education’ part of managing chronic asthma?

A
  • 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
19
Q

What is step one of chronic asthma management?

A

Low dose Inhaled Corticosteroid (ICS) e.g. Beclometasone Dipropionate​ & Short Acting Beta Agonist (SABA) e.g. Salbutamol

20
Q

What is step two of chronic asthma management?

A

Add a Long Acting Beta Agonist (LABA) e.g. Formetarol​ - usually this is prescribed in a combination inhaler e.g. Fostair or Relvar

21
Q

What is step three of chronic asthma management?

A

Add a leukotriene receptor antagonist (LTRA) e.g. Montelukast 10mg OD​. Alternatively, add Tiotropium or consider increasing ICS​ or If required, refer to specialist.

22
Q

What is step four of chronic asthma management?

A

Add a steroid (e.g. Prednisolone) or consider increasing ICS​ and refer to a specialist

23
Q

When do you step up the management plan?

A

If having to use SABA more than 3 times a week on top of current treatment

24
Q

What are the indications of a moderate acute asthma attack?

A

Increasing symptoms, PEFR > 50 – 75% of best and no features of a severe acute attack

25
Q

What are the indications of a severe acute asthma attack?

A

RR > 25, P > 110, PEFR 33 – 50% of best or predicted and inability to complete sentences

26
Q

What are the indications of a life threatening asthma attack?

A

O2 < 92%, PaO2 <8, normal PaC02, PEFR < 33 best or predicted and any of the following: Altered level of consciousness, silent chest, poor respiratory effort, cyanosis, hypotension or arrhythmia

27
Q

What is the management of an acute asthma attack?

A

O SHIT MAN
1. Oxygen 100% through 15L non-rebreather mask
2. Salbutamol 5mg (every 15 mins) Nebulised back-to-back.
3. Hydrocortisone IV 100mg (or Prednisolone PO)
4. Ipratropium Bromide 0.5mg Nebulised 4-6 hourly
5. Theophylline IV or aminophylline IV
6. Magnesium and call an
7. Anaesthetist

First Year (71 decks)

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