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Medicine - Respiratory > Chronic - Asthma > Flashcards

Chronic - Asthma Flashcards

1
Q

At what age can asthma be diagnosed?

A

5 and above

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2
Q

What is the diagnosis when children present with wheeze at <5 years?

A

‘preschool wheeze’ - if they still have symptoms of asthma at 5 years carry out spirometry with bronchodilator reversibility and if inconclusive, fractional exhaled nitrous oxide

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3
Q

How are children under 5 with wheeze managed?

A

Treat symptoms based on observation and clinical judgement:

  • Start a short-acting beta-2 agonist inhaler e.g. salbutamol as required
  • Add a regular low dose corticosteroid inhaler or a Leukotriene receptor antagonist i.e. oral montelukast
  • Add the other option from step 2.
  • Refer to a specialist
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4
Q

Name 5 risk factors of asthma.

A
  • Personal or family Hx of atopy
  • Antenatal factors - maternal smoking, viral infection during pregnancy
  • Low birth weight
  • Parental smoking around child
  • Air pollution
  • ‘Hygiene hypothesis’
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5
Q

What other IgE-mediated atopic conditions might someone with asthma present with?

A
  • Atopic dermatitis - eczema
  • Allergic rhinitis - hayfever
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6
Q

What should be examined in a patient presenting with asthma?

A

Resp exam

Examine nares - patients who are most sensitive to asthma often suffer from nasal polyps

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7
Q

What are the symptoms and signs of asthma?

A

Symptoms

  • cough, dyspnoea, ‘wheeze’, ‘chest tightness’
  • diurnal variation - symptoms usually worse at night/early morning
  • decreased exercise tolerance
  • disturbed sleep

Signs

  • nasal polyps
  • widespread polyphonic expiratory wheeze on auscultation
  • reduced peak expiratory flow rate (PEFR)
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8
Q

What parts of the social history are important in patients with asthma?

A
  • Pets?
  • Occupation - 110-15% of adult asthma cases are related to allergens in the work place e.g. isocyanates, flour
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9
Q

How is asthma diagnosed?

A
  • 1st line
    • Spirometry with bronchodilator reversibility
    • Fractional exhaled nitric oxide
  • If there is still diagnostic uncertainty, further testing:
    • Peak flow variability - diary several times a day for 2-4 weeks
    • Direct bronchial challenge test with histamine or methacholine
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10
Q

List some typical triggers for asthma.

A
  • Infection
  • Exercise
  • Cold air
  • Allergens - pollen, dust
  • Stress
  • Animals
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11
Q

What additional test would be recommended in adults presenting with symptoms suggestive of asthma who smoke?

A

CXR - rule out COPD, lung cancer

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12
Q

Is exhaled nitric oxide raised or decreased in asthma?

A

exhaled nitric oxide is raised in asthma (inflamed airways)

nitric oxide is produced by 3 types of nitric oxide synthases (NOS).

one of the types is inducible (iNOS) and levels tend to rise in inflammatory cells, particularly eosinophils

levels of NO therefore typically correlate with levels of inflammation.

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13
Q

What would be seen on spirometry with asthma?

A

FEV1 - significantly reduced

FVC - normal

FEV1% (FEV1/FVC) < 70%

Improvement in FEV1 with bronchodilator

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14
Q

What is the step-wise management of asthma in children aged 5-16?

A
  1. SABA
  2. SABA + low-dose ICS
  3. SABA + low-dose ICS + LTRA
  4. SABA + low-dose ICS + LABA (stop LTRA)
  5. SABA + switch ICS/LABA for a MART that contains low-dose ICS
  6. SABA + moderate-dose ICS MART
  7. specialist advice - consider high-dose ICS, theophylline
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15
Q

What is the step-wise management of asthma in people aged >16?

A
  1. SABA
  2. SABA + low-dose ICS
  3. SABA + low-dose ICS + LTRA
  4. SABA + low-dose ICS + LTRA + LABA
  5. SABA + switch ICS/LABA for a MART that contains low-dose ICS
  6. SABA + moderate-dose ICS MART
  7. specialist advice - consider high-dose ICS, theophylline or LAMA
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16
Q

What is the difference between salmeterol and formeterol?

A

Salmeterol = LABA slow onset with long duration

Formeterol = LABA fast onset with long duration (this is what is used in maintenance and reliever therapy)

17
Q

How do inhaled beta 2 agonists work?

A

Beta 2 agonists bind to beta-2 adrenoreceptors and cause smooth muscle relaxation in the bronchioles

18
Q

What are side effects of regular use of inhaled beta 2 agonists?

A

tachycardia, palpitations, tremor (these limit use of these drugs at high doses)

19
Q

A parent asks whether a steroid inhaler will affect their childs growth. How would you respond?

A
  • A common question is whether they slow growth – there is evidence that inhaled steroids can slightly reduce growth velocity and can cause a small reduction in final adult height of up to 1cm when used long-term (longer than 12 months), this effect is dose dependent so there is less of a problem with smaller doses
  • Explain that inhaled corticosteroids are effective medications that work to prevent poorly controlled asthma and asthma attacks that could lead to higher doses of oral steroids being given. Poorly controlled asthma can lead to a more significant impact on growth and development. The child will have regular asthma reviews to ensure they are growing well and on the minimal dose to effectively control symptoms
20
Q

What should be given alongside inhalers especially to children

A

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21
Q

What four pieces of advice should be given to all children and adults newly diagnosed with asthma?

A
  • Self-management education and personalised asthma action plan. Peak flow meter given with advice on how to use regularly as part of their personalised plan which tells them what to do in an exacerbation
  • Ensure up to date with all routine vaccinations + annual flu vaccine
  • Advise to avoid triggers
  • Smoking cessation - parents and carers of children
22
Q

What 4 questions can you ask a patient to identify whether their asthma is well controlled?

A

Have you had difficulty sleeping because of your asthma symptoms?

Have you had your usual asthma symptoms during the day (cough, wheeze, chest tightness, breathlessness)?

Has your asthma interfered with your normal activities?

Have you had to use your rescue inhaler more than once a week?

23
Q

What follow-up advice can be offered to all patients with asthma?

A

Yearly asthma review with specialist asthma nurse - check inhaler technique and adherence

Medicine - Respiratory (10 decks)

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