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Year One - Respiratory System > Chronic Asthma > Flashcards

Chronic Asthma Flashcards

1
Q

What is asthma?

A

It is a chronic inflammatory airway disease
leading to variable airway obstruction

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2
Q

What hypersensitivity reaction is associated with asthma?

A

Type 1

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3
Q

What is the pathophyiosology of asthma?

A

In asthma patients, the smooth muscle within the airways is hypersensitive, responding to stimuli by constricting and therefore causing airflow obstruction

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4
Q

What is the key characteristic feature of the bronchoconstrcition associated with asthma?

A

It is reversible

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5
Q

What are the nine risk factors of asthma?

A

Atopy Personal/Family History

Antenatal Factors

Low Birth Weight

Bottle Feeding

Obesity

Allergen Exposure

Air Pollution

Hygiene Hypothesis

Occupation

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6
Q

What is atopy?

A

It is defined as the body’s predisposition to develop an antibody called immunoglobulin E in response to environmental allergens

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7
Q

What is more influential - maternal or paternal atopy?

A

Maternal

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8
Q

What are the three main atopic conditions?

A

Asthma

Atopic dermatitis (eczema)

Allergic rhinitis (hayfever)

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9
Q

What two genes are associated with asthma?

A

ADAM33

ORMDL3

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10
Q

What two antenatal risk factors are associated with asthma?

A

Maternal Smoking

Viral Infection

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11
Q

What antenatal viral infection is most commonly associated with asthma?

A

RSV

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12
Q

What is the hygiene hypothesis?

A

It refers to reduced exposure to infectious agents in childhood resulting in abnormal development of the immune system - specifically resulting in a Th2 predominant response

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13
Q

What is the most common occupational risk factor of asthma?

A

Isocyanate exposure

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14
Q

What are the three clinical features of asthma?

A

Dry Cough

Dyspnoea

Bilateral Expiratory Wheeze

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15
Q

What are the two characteristics of the clinical features associated with asthma?

A

Episodic

Diurnal variability - worse in the early morning and night

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16
Q

What clincal feature indiciates a differential diagnosis to asthma?

A

Peripheral paraesthesia during dyspnoea episodes

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17
Q

List seven common triggers of asthma

A

Infection

Dust

Exercise

Animals

Smoking

Cold air

Food allergens

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18
Q

What three food allergens commonly trigger asthma?

A

Peanuts

Shellfish

Eggs

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19
Q

In most cases how is asthma diagnosed?

A

Clinically

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20
Q

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

A

Spirometry

Peak Flow Meter

Fractional Exhaled Nitric Oxide (FeNO)

Direct Bronchial Challenge Test

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21
Q

What two things need to be proven through investigations, in order to confirm a diagnosis of asthma?

A

Airflow obstruction

Airflow obstruction reversibility

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22
Q

What are the two first line investigations used to diagnose asthma?

A

Spirometry

FeNO

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23
Q

What is spirometry?

A

It is an investigation that measures the volume and flow of air during exhalation and inhalation

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24
Q

What three metrics are obtained from spirometry?

A

Forced Expiratory Volume 1 (FEV1)

Forced Vital Capacity (FVC)

FEV1 : FVC

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25
Q

What is FEV1?

A

It is defined as the volume that has been exhaled at the end of the first second of forced expiration

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26
Q

What is FVC?

A

It is defined as the volume that has been exhaled after a maximal expiration, following a full inspiration

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27
Q

What four spirometry results indicate a diagnosis of asthma?

A

Reduced FEV1

Normal FVC

FEV1 : FVC < 70%

Increased TCLO

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28
Q

Following abnormal spirometry results, what should be tested?

A

We test the reversibility of airflow obstruction

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29
Q

In what two ways can we test reversibility of airflow obstruction with spirometry?

A

Bronchodilator response

Corticosteroid response

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30
Q

Describe how bronchodilators can be used to test the reversibility of airflow obstruction in spirometry

A

We administer 400ug inhaled salbutamol or 2.5-5mg nebulised salbutamol

We conduct spirometry tests 15 minutes following administration

The results are deemed to demonstrate reversibility when FEV1 > 400ml or FEV1 of > 12%

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31
Q

Describe how corticosteroids can be used to test the reversibility of airflow obstruction in spirometry

A

We administer 30mg oral prednisolone for a period of 14 days or 500mcg inhaled beclomethasone for a period of 6 weeks

The results are deemed to demonstrate reversibility when FEV1 > 400ml or FEV1 of > 12%

32
Q

In cases where spirometry results are normal, however clinical suspicion remains high what is the most appropriate next step? Why?

A

FeNO

This is due to the fact that normal spirometry doesn’t exclude asthma as a diagnosis

33
Q

What are peak flow meter tests?

A

They involve the patients blowing as hard and as fast as they can into a small handheld device

This measures the rate at which air is exhaled from the lungs, obtaining a peak expiratory flow (PEF) score in litres of air breathed out per minute

34
Q

How can peak flow meter tests be used to diagnose asthma?

A

We ask patients to conduct peak flow meter readings at home twice daily for a period of 2 – 4 weeks

These readings are then plotted upon a chart, which incorporate the patient’s age, height and sex

35
Q

What three peak flow meter test results indicate asthma?

A

Morning/nocturnal dips

A gradual decline of results over

A variability of results greater than 20% on more than 3 consecutive days of the week

36
Q

What are FeNO tests?

A

They measure the level of nitric oxide in the exhaled breath, providing information about the eosinophilic inflammation in the lungs

37
Q

How do FeNo test results provide information about eosinophilic inflammation in the lungs?

A

This is due to the fact that nitric oxide is produced by inducible nitric oxide synthase (iNOS), with levels increasing in inflammatory cells – particularly eosinophils

Therefore, the level of nitric oxide correlated with the levels of inflammation.

38
Q

What FeNO result indicates a diagnosis of asthma?

A

> 40 parts per billion

39
Q

What is a direct bronchial challenge test?

A

It involves gradually increasing doses of medications that can irritate the airways to precipitate airway constriction

It therefore measures hypersensitivity of the airways

40
Q

What three medications can be used in direct bronchial challenge tests?

A

Histamine

Methacholine

Mannitol

41
Q

What direct bronchial challenge results indicate a diagnosis of asthma?

A

There are reduced medication doses required to precipitate constriction

42
Q

What are the seven pharmacological management options of asthma?

A

Short Acting Beta-2 Agonists (SABA)

Inhaled Corticosteroids (ICS)

Long Acting Beta-2 Agonists (LABA)

Long Acting Muscarinic Agonists (LAMA)

Leukotriene Receptor Antagonists (LTRA)

Maintenance & Reliever Therapy (MART)

Oral Theophylline

43
Q

Name two SABA inhalers

A

Salbutamol

Terbutaline

44
Q

Salbutamol is what inhaler colour?

A

Blue

45
Q

When are SABA inhalers used to treat asthma?

A

They are the first line pharmacological option

46
Q

What is another term for SABA inhalers? Why?

A

Reliever inhalers

They are used to relieve acute asthma features as required

47
Q

What is the mechanism of action of SABA inhalers?

A

Adrenalin enables relaxation of the smooth muscle in the airways

48
Q

What is the main side effect of SABA?

A

Tremor

49
Q

Name three inhaled corticosteroid inhalers used to manage chronic asthma

A

Beclomethasone dipropionate

Fluticasone propionate

Budeonside

50
Q

Beclomethasone dipropionate is what colour of inhaler?

A

Brown

51
Q

Fluticasone propionate is what colour of inhaler?

A

Purple

52
Q

When are ICS inhalers used to treat asthma?

A

They are the second line pharmacological option

53
Q

What is another term for ICS inhalers? Why?

A

Preventor inhalers

They should be administered by the patient every day regardless of whether the patient experiences asthma features

54
Q

At what frequency should ICS inhalers be initially administered?

A

Twice daily

55
Q

What are the two side effects of ICS inhalers?

A

Oral candidiasis

Stunted growth

56
Q

Name a LABA inhaler

A

Salmeterol

57
Q

When are LABA inhalers used to treat asthma?

A

They are the third line pharmacological option

58
Q

What is another term for LABA inhalers? Why?

A

Preventer inhalers

They should be administered by the patient every day regardless of whether the patient experiences asthma features

59
Q

What is the mechanism of action of LABA inhalers?

A

The adrenalin in these inhalers works to relax the smooth muscles within the airways

60
Q

Name a LAMA

A

Tiotropium

61
Q

When are LAMAs used to treat asthma?

A

They are the fourth line pharmacological options used to treat asthma

62
Q

What is another term for LABA inhalers? Why?

A

Preventer inhalers

They should be administered by the patient every day regardless of whether the patient experiences asthma features

63
Q

What is the mechanism of action of LAMAs?

A

Acetylcholine receptors are stimulated by the parasympathetic nervous system and cause contraction of the bronchial smooth muscle

LAMAs inhibit the acetylcholine receptors and therefore prevent its effects

64
Q

Name an LTRA

A

Oral montelekast

65
Q

When are LTRAs used to treat asthma?

A

They are the fourth line pharmacological option

66
Q

What is the mechanism of action of LTRAs?

A

Leukotrienes are produced by the immune system to cause inflammation, bronchoconstriction and mucus secretion

LTRAs inhibit leukotrienes and therefore prevent its effects

67
Q

What is MART?

A

It is a form of combined inhaled corticosteroid and long acting beta-2 agonist treatment in a single inhaler

68
Q

How do we administer MART?

A

It can be administered for both daily maintenance therapy and to relieve acute asthma features as required

69
Q

When do we administer MART?

A

It is only recommended in individuals who have poorly controlled asthma

70
Q

When is oral theophylline used to treat asthma?

A

It is a fourth line management option

It should only be considered after trials of short/long acting bronchodilators or in those who are unable to administer inhaled therapy

71
Q

What is the mechanism of action of oral theophylline?

A

It works by relaxing bronchial smooth muscle and reducing inflammation

72
Q

Why does oral theophylline need to be closely monitored? How often do we conduct monitoring?

A

It has a narrow therapeutic window, therefore monitoring of plasma levels in the blood is required

This monitoring is conducted 5 days after treatment is initiated and 3 days following dose changes

73
Q

What are the six stepwise management options for asthma?

A

Short Acting Beta-2 Agonist (SABA) Inhaler As Required

Add An Inhaled Corticosteroid (ICS)

Add A Long Acting Beta-2 Agonist (LABA)

Consider Trial of Oral LTRA, Oral Beta 2-Agonist, Oral Theophylline or LAMA

Titrate Up The Inhaled Corticosteroid (ICS) Dose. Combine Additional Treatments From Step Four

Specialist Referral

74
Q

How do we determine the efficacy of asthma management?

A

It is based upon the patient’s clinical history, rather than a specific investigation

For example, in patients who are requiring more than three doses of their SABA inhaler per week, we would recommend that their medication is reviewed accordingly

75
Q

What complication occurs when patients have a poor inhaler technique?

A

Oral candidiasis

76
Q

What is the diagnosis when individuals present with asthma, sinusitis, haematuria and eosinophilia?

A

Churg’s stress syndrome

Year One - Respiratory System (14 decks)

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