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Systems 1 - The Respiratory System > Clinical Features of Asthma > Flashcards

Clinical Features of Asthma Flashcards

1
Q

What is the definition of asthma?

A

A disease…

Hyperactive bronchi
Various Stimuli
Effect = narrowing of airways

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2
Q

Outline the prevalence of asthma in children and its distribution between the sexes

A

10-15% M>F

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3
Q

Outline the prevalence of asthma in adults and its distribution between the sexes

A

5-10% F>M

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4
Q

Describe the morbidity statistics of asthma

A

1000 deaths per year in UK on average - often >60 years old and have comorbidities

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5
Q

Describe three confirmed risk factors

A

Genetics, occupation and lifestyle

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6
Q

In atopic asthma, which parent is more likely to have the greater effect on the occurrence in progeny

A

Maternal atopy is most influential (3X paternal)

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7
Q

What are the genetic associations of atopic asthma?

A
  • IL-4, IL-5 and IgE for immune response genes

- ADAM33 for airway genes

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8
Q

Give a few examples of occupational asthma stimuli

A

Isocyanates, colophony, Animal urine proteins

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9
Q

What are the proven effects of maternal smoking to the foetus?

A
  • Decreased FEV1
  • Increased airway responsiveness
  • Increased prevalence and severity of asthma
  • Increase in wheezy illness
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10
Q

Describe The Grandmother Effect - how is this explained

A

Mother smoked = 50% increased risk
Grandmother smoked = 100% increased chance
Both smoked = 150% increased risk

Suggests epigenetic modification of oocytes in grandmother

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11
Q

What are the four possible risk factors for asthma?

A

Obesity, Diet, Reduced exposure to microbes, Household pollution

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12
Q

What are the presenting symptoms that should indicate asthma?

A 
Wheeze (must be present) 
Dyspnoea 
Chest tightness
Cough (usually dry)
Sputum (occasionally)
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13
Q

List the potential triggers for asthma

A

Exercise, cold air, smoke, perfume, URTIs, Pets, Trees, Grass pollen, food, aspirin

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14
Q

How can asthma vary?

A

Daily - worse at morning and night
Weekly - Better at weekends or on holiday
Annual - Environmental

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15
Q

What is the criteria for diagnosis of occupational asthma?

A
  • Suspicion of work related symptoms
  • Working with a recognised sensitiser
  • Conformation by conclusive peak flow readings (2 hourly 5 day minimum, 2 pairs of exposed/unexposed periods
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16
Q

How can past medical history aid diagnosis of asthma?

A

Childhood asthma, eczema etc (atopic diseases)
Drug history - current or past inhalers, beta blockers (bronchospasm) and NSAIDs (inflammation) can also increase risk of asthma

17
Q

How can social history aid diagnosis of asthma?

A

Smoking, pets, occupation can all contribute to respiratory inflammation

18
Q

On examination, what can rule out asthma?

A

Clubbing, cervical lymphadenopathy, stridor, asymmetrical expansion, dull percussion note (indicates lobular collapse - need for effusion) or crepitations (crackling/rattling indicating bronchiectasis)

19
Q

Tests for FEV1 and FVC are essentially measures for what?

A

FEV1 - airway diameter

FVC - lung capacity

20
Q

If FEV1/FVC is below what percentage is a full lung function test ordered?

A

70%

21
Q

What does a LFT consist of?

A

Helium dilution - tests lung volume

CO transfer - tests gas exchange

22
Q

What is essentially the purpose of a LFT?

A

Excludes emphysema and COPD

23
Q

What is the step after ruling out COPD and Emphysema?

A

Assess reversibility of symptoms

24
Q

How is sensitivity to bronchodilator measured?

A

Spirometry done:

15mins afters 400 micrograms inhaled salbutamol
15 mims after 2-2.5 milligrams of nebulised salbutamol

25
Q

What percentage margin is considered greatly reversed in response to a bronchodilator?

A

deltaFEV1 >200ml and deltaFEV1 >15% baseline

26
Q

What type of drug is salbutamol?

A

B2 agonist

27
Q

What is the next step in lung investigation after no/little response to B2 agonist?

A

Reverseability to oral corticosteroids

28
Q

What is the drug and dosage and duration of the preferred corticosteroid used? How does this help?

A

0.6 miligrams/kg Prednisolone 14 days; distinguishes COPD from asthma

29
Q

If all standard investigations come back normal what is the next step?

A

Specialist investigation -

Response to metacholine/histamine
Exhaled nitric oxide

30
Q

What are other useful investigations that can be ordered?

A

Chest X-Ray: Hyperinflation, hyperlucent (decrease in density due to air trapped)
Atopy investigations: skin prick, total and specific IgE, full blood count (eosinophils)

31
Q

What criteria are used for objective assessment of asthma?

A 
Ability to speak
Heart rate
Respiratory rate 
Peak flow 
Oxygen saturation/ arterial blood gas

Systems 1 - The Respiratory System (25 decks)

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