Bronchial Asthma Flashcards
What are the types of asthma
-extrinsic
-intrinsic
What is the cause of extrinsic asthma
-allergy reaction
-hypersensitivity type 1
-igE mediated
(notes; ttt: omalizumab because it acts against igE)
What are the triggers of intrinsic asthma
-aspirin
-exercise
-stress
Definition of bronchial asthma
-it is a chronic inflammatory lung disease
-with bronchoconstriction and mucus secretion
What is the clinical triads of bronchial asthma
-wheezing
-cough
-paroxysmal dyspnea
It may also come with pleuritic chest pain
What are the characteristics of bronchial asthma
-obstruction
-inflammation
-hyper-responsiveness
List down the causes of bronchial asthma
-atopy
-family history and genetic
-activity: exercise-induced asthma
-drug: aspirin-induced asthma
-lifestyle: stress and obesity
What is the most common cause of bronchial asthma
-atopic asthma
During atopic asthma, what other features that may accompany the condition
-eczema
-hay fever
-allergic conjunctivitis
What is the purpose of asthma phenotyping
-to classify the asthma based on
-its age of onset
-atopic/non atopic
The major criteria of allergic asthma
-atopic dermatitis (eczema)
-parental asthma
-aeroallergen
The minor criteria of allergic asthma
-peripheral eosinophils > 4%
-wheezing
-food allergens
The causative agent of Allergic Bronchopulmonary Aspargellosis (ABPA)
Aspergillus fumigatus
What is the histological features of ABPA
-the presence of septae hyphae in the bronchus
What are the clinical features of ABPA
-bronchial obstruction due to mucoid impaction
-peripheral eosinophils
-IgE elevation
What are the clinical features of Aspirin-induced asthma
-nasal polyps
-elevation of the urinary leukotrienes
What are the general signs of bronchial asthma
-tachypnea
-tachycardia
-pulsus paradoxus
(Notes; pulsus paradoxus means increase of the pressure during inspiration)
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%
