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Year 3 - TCD > Case 2 - Asthma > Flashcards

Case 2 - Asthma Flashcards

1
Q

What are the 3 major characteristics of asthma?

A
  • Airflow obstruction
  • Bronchial hyper-responsiveness
  • Inflammation
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2
Q

What is the difference between atopic and non-atopic asthma?

A
  • Atopic has allergic triggers, is extrinsic, usually develops in childhood and is a Type 1 hypersensitivity reaction
  • Non-atopic usually develops later and is triggered by cold/exercise/virus
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3
Q

Which immunoglobulin is associated with asthma?

A

IgE

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4
Q

Which genetic factors can lead to asthma?

A
  • Maternal smoking
  • Intrauterine nutrition: hygiene hypothesis
  • Specific genes – these increase the risk of developing asthma
  • Family history of asthma
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5
Q

What environmental factors can lead to asthma?

A
  • Hygiene hypothesis
  • Excreta of house dust mites
  • Pollens
  • Exercise or emotion
  • Cold air
  • Respiratory tract infections
  • Animal fur, dander, saliva
  • Fungal spores
  • Occupational factors
  • Drugs (e.g. aspirin)
  • Environmental pollutants
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6
Q

What is childhood asthma?

A

Asthma that is diagnosed before the age of 12 and is normally due to genetic predisposition

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7
Q

What is adult onset asthma?

A

Type 1 hypersensitivity reactions to certain allergens and is mainly due to environmental factors

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8
Q

What are the differentials for asthma?

A
  • COPD
  • PE
  • Bronchitis
  • Pneumonia
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9
Q

What are the symptoms of asthma?

A
  • Chest tightness
  • Dyspnoea – difficulty breathing
  • Coughing
  • Wheezing
  • Sputum
  • Diurnal variation
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10
Q

What type of wheeze is present in asthma?

A
  • Polyphonic

- On expiration

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11
Q

Why is asthma diurnal?

A

– Symptoms are worse at night this is because cortisol (which is immunosuppressive) has diurnal variation.
- Less cortisol at night = less immunosuppression = more symptoms.

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12
Q

Which tests are done to diagnose asthma?

A
  • Spirometry

- Peak expiratory flow rate

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13
Q

What peak expiratory flow rate results diagnose asthma?

A

PEFR varies by at least 20% for 3 days in a week

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14
Q

How to diagnose asthma?

A
  • More than one of the symptoms of wheeze, breathlessness, chest tightness and cough
  • Occurring in episodes
  • No or minimal symptoms in-between
  • Diurnal variation
  • Personal history of atopic disorder (eczema)
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15
Q

What will asthma show as on spirometry?

A
  • Obstructive picture
  • Low FEV1
  • Low FEV1/FVC ratio (below 70%)
  • SABA bronchodilator reversibility
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16
Q

What additional tests are conducted in asthma?

A
  • Allergy testing
  • Sputum eosinophils (increased)
  • Methacholine challenge (asthma trigger, inhalation leads to asthma attack)
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17
Q

How to manage asthma?

A
  • Annual review
  • Vaccination (pneumococcal, flu)
  • Self monitor PEFR
  • SABA
  • Add low dose ICS
  • Add LABA (consider before increasing steroid)
  • Increase ICS or add LTRA (consider stopping LABA)
  • Refer to specialist
18
Q

What are the side effects of beta 2 agonists (salbutamol, salmeterol)?

A
  • Tachycardia
  • Tremor
  • Hypokalaemia
  • Dizziness
  • Headache
  • Arrhythmia
  • Paradoxical bronchospasm
19
Q

Which class of medication does montelukast belong to?

A

Leukotriene receptor antagonists

20
Q

Which class of medications does ipratropium belong to?

A

Anti-muscarinics

21
Q

What are the side effects of antimuscarinics (ipratropium)?

A
  • Dry mouth
  • Nausea
  • Headache
22
Q

Which class of medications does theophylline belong to?

A

Phosphodiesterase inhibitors

23
Q

What are the side effects of PDE inhibitors (theophylline)?

A
  • Tachycardia
  • Arrhythmias
  • Agitation
  • Hypokalaemia
  • Convulsions
24
Q

What is a preventer inhaler?

A
  • Glucocorticoids

- Once a day

25
Q

What are the side effects of glucocorticoids?

A
  • Candidiasis: Oral thrush, need to check mouth
  • HTN
  • Indigestion
  • Adrenal suppression
  • Osteoporosis
  • Hoarseness
26
Q

How to treat mild intermittent exercise induced asthma?

A
  • SABA PRN
27
Q

How to treat mild persistent asthma?

A
  • Low dose ICS

2nd line - LTRA or theophylline

28
Q

How to treat moderate persistent asthma?

A
  • Increase dose of ICS OR

- Add LABA

29
Q

How to treat severe persistent asthma?

A
  • Medium dose ICS

- Then increase to high dose ICS but monitor patient symptoms

30
Q

What is moderate acute asthma?

A
  • Increasing symptoms
  • PEF >50-75% best or predicted
  • No features of acute severe asthma
31
Q

What is acute severe asthma?

A
  • PEF 33-50% best or predicted
  • Respiratory rate >25/min
  • Heart rate >110/min
  • Inability to complete sentences in one breath
32
Q

What is life-threatening asthma?

A
  • PEF <33% best or predicted
  • SpO2 <92%
  • PaO2 <8 kPa
  • Normal or rising PaCO2 (4.6–6.0 kPa)
  • Altered conscious level
  • Exhaustion
  • Silent chest
  • Arrhythmia
  • Cyanosis
33
Q

What is the management of acute asthma?

A

O SHIT ME

  • Oxygen
  • Salbutamol (5 mg nebulised)
  • Hydrocortisone (100 mg IV, then 40-50 mg for min 5 day)
  • Ipratropium bromide (0.5 mg nebulised)
  • Theophylline
  • IV magnesium sulphate (1.2-2g for 20 mins)
  • Escalate to ICU
34
Q

When to refer to ICU in acute asthma?

A
  • Hypercapnia
  • Drowsiness
  • Altered conscious state
  • Confusion
  • Requiring ventilatory support
35
Q

What 3 questions to ask in asthma annual review?

A

1 - Have you had difficulty sleeping because of your asthma symptoms (including cough)?
2 - Have you had your usual asthma symptoms during the day?
3 - Has your asthma interfered with your usual activities (house hold work, work, school)?

36
Q

What is involved in annual review?

A
  • 3 questions
  • Flu vaccination
  • Pneumococcal vaccination
  • Smoking cessation
37
Q

What are the differentials for bruising?

A
  • Steroid use (Cushing’s, resulting in thinner skin)
  • Depression with self-harming behaviour
  • Domestic violence
  • Sports-related trauma
38
Q

What are the support agencies for domestic violence?

A
  • Social Services
  • Police adult safeguarding
  • PCT adult safeguarding units
39
Q

What is SBAR?

A

Emergency protocol

  • Situation: overview of event
  • Background: patient history
  • Assessment: examination findings
  • Recommendation: DDx, investigations/treatment
40
Q

Bronchodilator reversibility in spirometry is an increase in FEV1 of X?

A

12% or 200ml

Year 3 - TCD (17 decks)

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