bronchial asthma part 1 Flashcards
what is the definition of asthma ?
is a heterogenous disease ( with many phenotypes), which is variable
what is the difference between COPd and asthma ?
with COPD there is persistent symptoms along with airflow obstruction
whilst with asthma there are variable symptoms along with airflow limitations
what is the difference between a risk factor and a trigger ?
a risk factor causes pathological changes whilst a trigger would cause an acute attack
what is the pathophysiology in asthma patients?
airway hyper-responsiveness
hyper-reactivity to trigger
trigger normally not affect non asthmatics
bronchospasm
what is the clinical picture of asthma ?
have more than one symptom :
1- variable overtime and in intensity
2- often occur and worsen at night
3- often occur with viral infections
4- often triggered by exercise, cold air
when are we less likely to detect asthma?
with an isolated cough chronic sputum production chest pain dyspnea with dizziness or paresthesia dyspnea with noisy inspiration ( stridor)
what are the physiological tests required to make a diagnosis of asthma ?
spirometry
peak expiratory flow meter
bronchial provocation tests
what is reversibility testing ?
performing a spirometry before and after medications
usually given a salbutamol dose of 200-400mg and then the FEV1 should increase by 200 ml and by 12%
what is the cutoff value for the FEV1/FVC ration in order to make a diagnosis of asthma ?
less than 80%
what is the daily diurnal variability ?
take the PEF value in the morning then PEF value in the afternoon , ( mean reading of 3) subtract values from each other divided by the mean x 100
a value exceeding 10% is diagnostic of bronchial asthma
what is the purpose of the bronchial challenge test ?
detect airway hyper sensitivity
how is the bronchial challenge test performed ?
by measuring FEV1 pre and post inhalation of histamine or metacholine
what is the value for diagnosis of asthma using the bronchial challenge test ?
fall in FEV1 by 20% or more
what other tests can help in the diagnosis of asthma ?
increased fractioned expired nitric oxide in breath
increased blood or sputum eosinophils
increased blood/eosinophils in sputum
what are the general available treatment options for bronchial asthma ?
anti inflammatory ( ICS, OCSS, LTRA)
bronchodilators ( b2 agonist, anti-muscarinic)
other treatments ( biologic, azithromycin, bronchial thermoplasty )
how must ICS be used with asthma patients ?
used as a reliever in acute attacks and a controller for long term
used alone or combined with SABA, LABA, LAMA or LTRA
and must be given in stepwise doses : low, intermediate and high
what are the side effects of ICS ?
oral candidiasis, hoarseness of voice
risk of pneumonia with high dose
what is the method of administration with OCS ?
oral or intravenous
when are OCS usually used ?
in exacerbations and not in regular treatments
what are the side effects of OCS ?
immunosuppression: risk of infection
muscle weakness
gastritis/ peptic ulcer
hypertension, hyperglycemia, edema
osteoporosis
addisonian crisis
Addisonian crisis
how are leukotriene receptor antagonists administered ?
oral or iv not by inhalation
what is an example of a LTRA and when can leukotriene receptor agonists be used ?
montelukast
with patients intolerant to ICS side effects
allergic rhinitis/sinusitis
what precautions must be taken with leukotriene receptor agonists ?
neuropsychiatric problems
what drugs should be avoided with asthma patients ?
aminophylline and theophylline (methylxanthine)
