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Respiratory System > Clinical features of asthma > Flashcards

Clinical features of asthma Flashcards

1
Q

What is the definition of asthma?

A

A disease characterised by an increased responsiveness of the trachea and bronchi to various stimuli and manifested by a widespread narrowing of airways that changes in severity either spontaneously or as a result of therapy.

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2
Q

What 2 paths can airway inflammation mediated by the immune system go down?

A
  • Widespread narrowing of airways

- Increased airway reactivity > Airway narrowing > Spontaneously or Stimuli.

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3
Q

Is asthma more common in males or females in children?

A

More common in males

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4
Q

Is asthma more common in males or females in adults?

A

More common in females

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5
Q

What are proven risk factors for asthma?

A
  • Genetic: Atopy
  • Occupation
  • Smoking
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6
Q

Features of Atopy in asthma

A
  • Inherited tendency to IgE response to allergens.

- Strongest risk factor: personal, familial atopic tendency, Maternal atopy most influential.

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7
Q

Which two groups of genetic association genes are linked to asthma?

A
  1. Immune response genes: IL-4, IL-5, IgE

2. airway genes: ADAM33

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8
Q

What changes can maternal during pregnancy cause?

A
  • Decreased FEV1
  • Wheezy illness
  • Increased responsiveness
  • Increased asthma and severity
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9
Q

What are possible risk factors for asthma?

A
  • Obesity
  • Diet
  • Reduced exposure to microbes/microbial products.
  • Indoor pollution: chemical household products
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10
Q

Clinical aspects of asthma

A
  • It is a reversible obstruction
  • Daily symptom variability
  • Family history
  • No smoking
  • Allergy, rhinitis, eczema maybe.
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11
Q

What is the most important aspect when diagnosing asthma?

A

HISTORY

Symptoms: wheeze, short of breath (dyspnoea), severity chest tightness (pain), cough, paroxysmal, usually dry sputum.

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12
Q

What are evidence of variable symptoms?

A
  • Triggers :exercise, cold air, smoke, perfume, URTI’s, pets, tree, grass pollen, food, aspirin.
  • Daily/ weekly/ Annually variation
  • PMH
  • Drugs
  • FMH
  • PSH
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13
Q

What examination findings is usually unhelpful in clinic?

A
  • Breathless on exertion
  • Hyperexpanded chest
  • Polyphonic wheezes
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14
Q

What findings mean its probably not asthma?

A
  • Clubbing, cervical lymphadenopathy
  • Stridor- hard inspiratory wheeze, blocking of trachea or proximal bronchi.
  • Assymetrical expansion
  • Dull percussion note
  • Crepitations
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15
Q

What evidence are you looking for in an essential investigation for asthma?

A
  • Airflow obstruction

- Variability and/or reversibility of airflow obstruction

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16
Q

Examples of essential investigations for asthma?

A
  • If obstructed: Full pulmonary function testing
  • Reversibility to bronchodilator
  • Reversibility to oral corticosteroids
  • If normal spirometry: variability to airflow obstruction.
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17
Q

Features of full pulmonary function testing

A
  • Effectively excluding COPD/emphysema
  • Lung volumes (helium dilution)
  • Carbon monoxide gas transfer (transfer of CO to Hb across alveoli)
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18
Q

Features of reversibility to bronchodilator

A
  • Response to bronchodilator
  • Significant reversibility: FEV1>200ml & FEV1>15% baseline
  • no bronchoconstriction, no reversibility
  • severe bronchoconstriction, no reversibility
19
Q

Features of reversibility to corticosteroids

A
  • Response to corticosteroids (anti-inflammatory)
  • Useful if obstructed, reversibility, variability.
  • Separates COPD from asthma
20
Q

Features of airflow obstruction

A

Analysis subjective:

  • morning/nocturnal dips
  • decline over weeks/days
  • variability > 20%
21
Q

Diagnosis of occupational asthma

A
  • Suspicion from work related symptoms.
  • Working with recognised occupational sensitiser
  • Confirmation- serial peak flow readings, antibodies, bronchial challenge, positive response to colophony.
22
Q

Specialist investigations for asthma

A
  • Airways responsiveness to methacholine/histamine.
  • Exhaled nitric oxide (NO)
    Give substances that you know will cause bronchoconstriction
23
Q

Useful investigations for asthma

A
  • Chest X-Ray
  • Skin prick testing (atopic status)
  • Total and specific IgE (atopic status)
  • Full blood count
24
Q

Moderate symptoms of asthma

A
  • Able to speak, complete sentences
  • HR <110
  • RR <25
  • PEF 50 - 75% predicted or best
  • SaO2 > 92% (no need for ABG)
  • PaO2 > 8kPa
25
Q

Severe symptoms of asthma

A
  • Unable to speak, unable to complete sentences
  • HR >110
  • RR >25
  • PEF 33 - 50% predicted or best
  • SaO2 > 92%
  • PaO2 > 8kPa
26
Q

Life threatening symptoms of asthma

A
  • Grunting
  • Impaired consciousness, confusion, exhaustion
  • HR >130, or bradycardic
  • Hypoventilating
  • PEF < 33% predicted or best PEF=peak flow
  • Cyanosis
  • SaO2 < 92%
  • PaO2 < 8kPa
  • PaCO2 normal (4.6 - 6.0kPa)
27
Q

Life threatening symptoms of asthma

A

Same as life threatening symptoms but

Raised PaCO2

28
Q

Features of asthma

A
  • Literally “panting”
  • Chronic
  • Wheeze, cough and SOB
  • Multiple triggers: URTI, exercise, allergen, cold weather etc.
  • Variable/reversible
  • Responds to asthma Rx
  • No uniform definition
29
Q

What are some of the multiple hits that lead to asthma?

A
  • Genes
  • Inherently abnormal lungs
  • Early onset atopy
  • Later exposures: Rhinovirus, exercise, smoking.
30
Q

What is the key information used to diagnose asthma?

A

History of patient

31
Q

Methods for objective testing for asthma in children

A
  • Spirometry
  • Bronchodilator reversibility
  • FeNO
    Do not diagnose base asthma only based on spirometry and BDR, make sure you check FeNO
32
Q

Features of wheeze in asthma

A
  • A “must have”
  • Cough variant asthma does not exist
  • Cough predominant asthma not uncommon
33
Q

Features of Atopy

A
  • Does not “cause” asthma: Atopy and asthma secondary to same process,
    URTI primary precipitant
  • Personal history: eczema, hayfever, food allergies.
  • Family history
34
Q

What are the ideal symptoms/reactions which would allow the diagnosis of asthma?

A
  • Wheeze, shortness of breath at rest
  • Multi trigger
  • Atopy
  • Parental asthma
  • Responds to treatment
35
Q

Features of small print for differential diagnosis for asthma

A
  • Foreign body
  • Cystic fibrosis
  • Immune deficiency
  • Ciliary dyskinesia
  • Tracheo-bronchomalacia
  • Aspiration
    Cystic fibrosis, immune deficiency and ciliary dyskinesia are all secretions.
36
Q

What is used to treat infrequent episodic wheeze with a cold

A

Salbutamol

37
Q

What should you NOT use to treat infrequent episodic wheeze with a cold

A
  • Oral steroids in hospital
  • Oral steroids at home
  • Short “burst” at home
  • Short “burst” of LTRA
38
Q

When could it be infection and not asthma

A
  • Under 18 months old, most likely infection.
  • Over 5 years, most likely asthma.
    HOWEVER, if it sounds like asthma and responds to asthma it is asthma regardless of age!
39
Q

Features of bronchitis

A
  • Common
  • Loose rattly cough
  • Noisy breathing
  • Child is very well
  • Chest free of wheeze/creps
  • Self-limiting
40
Q

Mechanisms of bacterial bronchitis

A
  • Disturbed mucociliary clearance: RSV/adenovirus/rhinovirus, haemophilus culture medium, >4 week recovery
  • Infection secondary
  • Lack of social inhibition
41
Q

Features of Pertussis

A
  • This is common
  • Vaccination reduces risk
  • “coughing fits”
  • Vomiting, colour change, petechiae
42
Q

When is it not asthma in preschool children

A

Cough and noisy breathing

  • Bronchitis (2-3 year old, wet cough)
  • Tracheomalacia (Life long loud cough)
  • Small print
  • Pertussis
43
Q

When is it not asthma in school aged children?

A

Cough and noisy breathing

  • Habitual cough (8-12 year old, single loud cough)
  • Dysfunctional breathing
  • Vocal cord dysfunction
  • Pertussis (any age, fits, vomit, haematoma)
44
Q

Is there a test for asthma in children?

A

NO

  • There is no test for asthma in children.
  • There is no lower age limit for diagnosing asthma.

Respiratory System (28 decks)

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