Bronchial Asthma Flashcards by Daniel Aznor

What are the types of asthma

-extrinsic
-intrinsic

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What is the cause of extrinsic asthma

-allergy reaction
-hypersensitivity type 1
-igE mediated

(notes; ttt: omalizumab because it acts against igE)

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What are the triggers of intrinsic asthma

-aspirin
-exercise
-stress

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Definition of bronchial asthma

-it is a chronic inflammatory lung disease
-with bronchoconstriction and mucus secretion

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What is the clinical triads of bronchial asthma

-wheezing
-cough
-paroxysmal dyspnea

It may also come with pleuritic chest pain

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What are the characteristics of bronchial asthma

-obstruction
-inflammation
-hyper-responsiveness

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List down the causes of bronchial asthma

-atopy
-family history and genetic
-activity: exercise-induced asthma
-drug: aspirin-induced asthma
-lifestyle: stress and obesity

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What is the most common cause of bronchial asthma

-atopic asthma

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During atopic asthma, what other features that may accompany the condition

-eczema
-hay fever
-allergic conjunctivitis

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What is the purpose of asthma phenotyping

-to classify the asthma based on
-its age of onset
-atopic/non atopic

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The major criteria of allergic asthma

-atopic dermatitis (eczema)
-parental asthma
-aeroallergen

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The minor criteria of allergic asthma

-peripheral eosinophils > 4%
-wheezing
-food allergens

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The causative agent of Allergic Bronchopulmonary Aspargellosis (ABPA)

Aspergillus fumigatus

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What is the histological features of ABPA

-the presence of septae hyphae in the bronchus

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What are the clinical features of ABPA

-bronchial obstruction due to mucoid impaction
-peripheral eosinophils
-IgE elevation

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What are the clinical features of Aspirin-induced asthma

-nasal polyps
-elevation of the urinary leukotrienes

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What are the general signs of bronchial asthma

-tachypnea
-tachycardia
-pulsus paradoxus

(Notes; pulsus paradoxus means increase of the pressure during inspiration)

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What will be observed during inspection of bronchial asthma

-hyperinflated chest
-skin retraction over the intercostal space
-prolonged expiration
-use of accessory muscle

What will be observed during palpation of bronchial asthma

-decrease of tvf
-due to air trapping

What will be observed during percussion of bronchial asthma

-hyperresonant
-due to air trapping

What will be observed during auscultation of bronchial asthma

-wheezing
-diminished vesicular sound

What is different of Asthma and COPD regarding its agent

-sensitising agent
-noxious agent

What is different of Asthma and COPD regarding its inflammation reaction

-CD4 and eosinophils
-CD8, macrophage and neutrophils

What is different of Asthma and COPD regarding airway limitation

-reversible
-irreversible

What are the DD of bronchial asthma that also causes asthmatic syndrome

-cardiac asthma -renal asthma -fibrosing asthma -loeffler’s syndrome (parasitic infection) -polyarteritis nodosa -carcinoid tumour

What are the DD of bronchial asthma that also causes paroxysmal dyspnea

-tetany -mediastinal syndrome -myasthenia crises -poisoning -hysterical

What is status asthmaticus

-it is a severe and progressive attack of asthma -that lasts for more than 6 hours -with failure of therapy

What are the general signs of status asthmaticus

-tachypnea -tachycardia -pulsus paradoxus -decrease BP -cyanosis -increase of CO2

Why the blood pressure decreases in status asthmaticus

-due to increase of intra-thoracic pressure leads to decrease of venous return

What are the complications of the bronchial asthma

-status asthmaticus -COPD -respiratory failure -corpulmonale -pneumothorax

What are the severity of bronchial asthma

-intermittent -mild persistent -moderate persistent -severe persistent

Describe intermittent severity of bronchial asthma regarding; -days of symptoms -use of SABA -night awakening -FEV1 value -FEV1 variability

-≤2 days/week -≤2days/week -<2 times/month -≥80% -<20%

Describe mild persistent severity of bronchial asthma regarding; -days of symptoms -use of SABA -night awakening -FEV1 value -FEV1 variability

->2 days/week (not daily) ->2 days/week (not daily) -3-4 times/month -≥80% -<20-30%

Describe moderate persistent severity of bronchial asthma regarding; -days of symptoms -use of SABA -night awakening -FEV1 value -FEV1 variability

-daily ->once/week (not nightly) ->once/week (not nightly) -60-80% ->30%

Describe severe persistent severity of bronchial asthma regarding; -days of symptoms -use of SABA -night awakening -FEV1 value -FEV1 variability

-daily -daily -daily -≤60% ->30%

What are the types of bronchodilators used in the treatment of bronchial asthma

-b2 agonist -anticholinergic (m3 antagonist) -methylxanthine

What are the types of anti-inflammatory used in the treatment of bronchial asthma

-corticosteroid -leukotriene inhibitor (montelukas) -anti-histamine

What is the long term management of bronchial asthma

-avoidance of the triggers -inhaled corticosteroids

What is the step 1 treatment plan for bronchial asthma

-SABA when needed -Na chromoglycate 1 hour before exercise (Notes: Na chromoglycate is a mast cell stabilizer)

What is the step 2 treatment plan for bronchial asthma

-SABA when needed but not more than 3-4 times -daily ICS -LABA only for night symptoms

What is the step 3 treatment plan for bronchial asthma

-daily SABA -daily ICS -LABA or SR aminophylline for night symptoms

What is the step 4 treatment plan for bronchial asthma

-inhaled SABA when needed -daily ICS -LABA or SR theophylline -oral steroid on alternate days in the morning

What is the treatment plan for acute exacerbation of asthma

-O2 supply -inhaled SABA -anticholinergic

What are the criteria of ICU of acute asthmatic exacerbation

-PCO2>40 -PEF<25%