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Resp Week 2 > Clinical features of asthma in Adulthood > Flashcards

Clinical features of asthma in Adulthood Flashcards

1
Q

What is asthma?

A

Increased responsiveness of the airways, airflow or airway obstruction, and symptom variability.

Derived from the Greek term (aazein), meaning “to pant heavily” or “gasp for breath”

Complex disease or syndrome for which there is no universally accepted definition

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

When are asthma symptoms most marked?

A

Often at the beginning or end of the day

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3
Q

What are the symptoms of asthma?

A 
Wheezing
Shortness of Breath
Difficulty expiration
Chest tightness
Coughing
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4
Q

True or False:
Every day 3 people die from an asthma attack, 2/3 of deaths being preventable
Every 10 seconds someone is having a potentially life threatening asthma attack in the UK

A

True

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5
Q

What is the annual NHS cost of asthma?

A

£889million

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6
Q

What are the 3 proven risk factors for asthma?

A

Hereditary
Smoking
Occupation

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7
Q

What is Atopy?

A

Body’s predisposition to develop an IgE antibody (immunoglobulin E) in response to exposure to environmental allergens - inheritable trait.

Associated with allergic rhinitis, asthma, hay fever, and eczema

Risk of asthma increased if first degree family member has asthma or another atopic disease.

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8
Q

Is a paternal or maternal atopy more influencial?

A

Maternal atopy most influential (3x father).

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9
Q

What % of adult onset asthma can com from Occupation?

What type of work and how?

A

Underestimated (10-15% of adult onset asthma)

Isocyanates			twin pack paints
Colophony			welding solder flux
Laboratory animals	rodent urinary proteins
Grains				wheat proteins, grain mites
Enzymes			subtilisin, amylase
Drugs				antibiotics, salbutamol
Crustaceans			prawns, crabs
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10
Q

What are the possible risk factors for asthma (not for exams) but could explain increase in prevelance?

A

Obesity
Increased body mass index associated with asthma
Obesity pro- inflammatory

Diet
	Associations with:
Vitamin E,C and D
Selenium
Polyunsaturated fatty acids
Oily fish, Mediterranean diet, margarine

The “hygiene hypothesis”
Reduced exposure to microbes/ microbial products
Children born on farms less likely to develop asthma
Microbial diversity appears to be important in reducing the risk of asthma

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11
Q

What tests are done for airway obstruction?

A

Spirometry and bronchodilator reversibility

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12
Q

What other options are there for investigations?

A

Tetsing for variability:
reversibility
PEF charting
Challenge tests

Testing fro eosinophillic inflammartion or atopy:
FeNO
Blood eosinophils
Skin prick test, IgE

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13
Q

What do you look for in a clinical examination of someone with asthma?

A
  • recurrent episodes of symptoms
  • symptom variability
  • absence of symptoms of alternative diagnosis
  • recorded history of wheeze
  • personal history of atopy
  • historical record of variable PEF/FEV1
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14
Q

Symptoms of asthma

A 
Wheeze
Shortness of breath (dyspnoea), severity
Chest tightness
Cough, paroxysmal, usually dry
Sputum (occasional)
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15
Q

Give 3 examples of variation which might be shown

A 
Daily variation (nocturnal/ early morning)
Weekly variation (occupation, better at weekends & holidays)
Annual variation (environmental allergens)
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16
Q

What could be possible triggers for asthma?

A

Different for each individual.

Exercise
Cold air
Cigarette smoke
Perfumes/ strong scents
URTI’s
Pets
Tree or grass pollen
Food
Drugs (aspirin/ NSAIDS)
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17
Q

What would you ask about in past medical history?

A

Childhood asthma, bronchitis, wheeze in infancy
Eczma
Hayfever

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18
Q

What would you ask about in terms of drugs?

A

Current inhalers (check technique!), other asthma therapies, compliance
Beta-blockers, aspirin, NSAIDS
Effects of previous drugs/inhalers

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19
Q

What would you try to specifically ask about for family history?

A

Asthma and other atopic disease

20
Q

hat would you try to specifically ask about for in social history?

A

Tobacco, recreational drugs, vaping
Pets
Occupation (past and present)
Psychological aspects

21
Q

What may you find on clinical examination?

A

Usually unhelpful but may find:
Breathless on exertion
Hyperinflated chest
Wheeze

22
Q

What other diseases can cause wheeze, cough and dyspnoea?

A

Generalised airflow obstruction:
COPD (irreversible AFO)
Bronchiectasis
Cystic Fibrosis

Localised airway obstruction (inspiratory stridor= large airways):
Tumour
Foreign body

Cardiac

23
Q

Can FEV1/FVC ratio be normal in asthma?

A

Yes, it can be.

24
Q

What do you do on result of an obstructed spirometry assessment and why?
What counts as “obstructed”?

A

Obstructed = FEV1/FVC<70% , FEV1<80% predicted.

You do further examinations: full pulmonary function testing - to remove COPD/emphysema.

25
Q

What objective points do you look at when evaluating acute asthma ?

A 
think O SHIT
Oxygen satration/arterial blood gas
Speak ability
Heart rate
In - respIration rate
Test -PEF
26
Q 
Defferentiate Moderate and severe asthma:
Oxygen sats
Speak Ability
Heart Rate
respIratory rate
Test - PEF
SaO2
PaO2
A

Moderate: vs (Severe (any one of))
Essentially increasing symptoms,
no features of acute severe
Able to speak, complete sentences (inability to complete sentances in one breath)
HR < 110 (110+)
RR < 25 (25+)
PEF 50 - 75% predicted or best (33-50% predicted or best)
SaO2 ≥ 92% - no need for ABG
PaO2 ≥ 8kPa

27
Q

What are the signs of a life threatening asthma attack?

A

GAS 33 CCE

Grunting
Arrythmia/hypotention/bradycardia
Silent chest

PEF=33% predicted or best

Confusion/exhaustion/impaired consciousness
Cyanosis
Effort = poor for respiratory

28
Q

What would the stats be in a life threatening asthma attack?

A 
SaO2 less than 92% (Needs blood gas!)
PaO2 = less than 8kPa
PaCO2 cormal (4.6-6.0kPa)
29
Q

Mternal smoking has what affect on the new born?

A

reduction in FEV1

30
Q

What are the particular jobs which are high risk of developing asthma?

A

Bakers, Painters and shellfishworkers

31
Q

If asthmatics sputum is yellow or green , then does that mean they have a bacterial or viral infection?

A

No, not necessarily! Could just be the colour of the inflammatoty cells

32
Q

Can stress make asthma worse

A

Yes, likewise asthma can make stress worse

33
Q

If there is finger clubbing, cervical lymphadenopathy, stridor, assymetric expansion, dull percussion note, crepitations, is it probably asthma?

A

No

34
Q

Is the wheeze always there in adult asthma?

A

No

35
Q

What would stridor (inspiratory wheeze) point towards?

A

obstruction of large airway, eg tumour/foreign body obstruction of airways.

36
Q

What do we look at in spirometry?

A

FEV1 or FEV1/FVC

37
Q

What would indicate airflow obstruction in a spirometry reading?

A

less that 70% (FEV1/FVC)

38
Q

Will asthmatics have normal spirometry?

A

It may be normal if they don’t have any symptoms at the time or it may be reduced

39
Q

What do you consider if a suspect asthmatic has an obstructed spirometry result?

A

Full pulmonary function test and/or reversibility testing

40
Q

What does a Full Pulmonary function test do?

A

gas transfer test, gas ytransfer of CO to haemoglobin. In asthma, gas transfer is preserved or even can be increased, whereas COPD is reduced (alveolar reduction and destruction caused by smoking)

41
Q

What is a reversibility test?

A

FEV1 before and 15 mins after either inhaled or nebulised dose of Salbutamol (bronchodilator), and check to see if there is an improvement (which would be consistant with asthma)

42
Q

What level counts as “reversibility”?

A

Change in FEV1 greater than 200ml and 12% of baseline

43
Q

What is an alternative method for testing for reversibility?

A

A course of corticosteroids (anti-inflammatory) eg Prednisolone) for 14 days and keep a peak flow chart and meter. Also compare baseline and x2 week spirometry.

Significant and consistant improvement in peak flow over 2 weeks would suggest asthma (as shows responsiveness and reversibility)

44
Q

What is the course of action if patient presents with asthma but has a normal spirometry result

A

Asked to record peak flow over 2 weeks (at least twice daily.

Look for variability of greater that 20% over the recordings/trends/patterns

45
Q

In specialist investigations for asthma, what chemicals can be used and what are you looking for?

A

Chemicals used:
Methacholine
Histamine
Mannitol

Asthmatic patients FEV1 will drop off

46
Q 
Why may these aditional investigations be useful:
Chest X-ray
Skin Pick Testing
Total and specfic IgE
Full Blood Count
A

Chest X-ray: Hyperinflated, hyperlucent (no effusion, collapse, opacities, interstitial changes)
Basically trying to rule out if there is any lung consolidations that would fit with pneumonia, pleural effusions, lung cancers, interstitial lung disease

Skin prick testing (atopic status)

Total and specific IgE (atopic status)

Full blood count
Eosinophilia (atopy)

Resp Week 2 (10 decks)

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