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Respiratory System & CVS Physiology Year 1 > Clinical Features of Asthma in Adults > Flashcards

Clinical Features of Asthma in Adults Flashcards

1
Q

What is a definition of asthma?

A

(No universally accpted 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

What are the main symptoms of asthma?

A

wheezing, coughing, shortness of breath, chest tightness, together with difficulty in expiration, sputum (occasionally).

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3
Q

Why is asthma important?

A

It is common, dangerous and expensive.

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4
Q

What gender is thought to have the most cases of asthma in childhood?

A

Males

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5
Q

What gender is thought to have the most cases of asthma in adulthood?

A

Females.

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6
Q

What two disease processes result in asthma?

A

Widespread narrowing of airways and increased airway recativity

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7
Q

What can airway reactivity cause?

A

It can cause airway narrowing either sponatneously or to a stimuli.

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8
Q

What is atopy?

A

The body’s predisposition to to develop an antibody called immunoglobin E in response to exposure to environmental allergens and is an inheritable trait.

Such as asthma, eczema and hay fever.

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9
Q

What are proven risk factors for asthma?

A

Hereditary, Smoking, Ocupation, Obesity, Diet

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10
Q

Which parent is more important in passing on an atopical disease?

A

Mother by 3x

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11
Q

What is the hygiene hypothesis?

A

There is reduced exposure to microbes and so children born on farms are less likely to develop asthma

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12
Q

What are the types of variations of symtoms?

A
  • Daily variation (Nocturnal/early morning)
  • Weekly variation (occupation, better at weekends or holidays)
  • Annual variation (environmental allergens)
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13
Q

What are other triggers to asthma?

A

Exercise, cold air, cigarette smoke, perfumes, Pets, Tree, Pollen, Food and drugs.

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14
Q

What are important questions to ask in the past medical history of an asthmatic patient?

A

Childhood asthma
Wheeze
Eczema
Hay Fever.

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15
Q

What are important questions to ask about during the history?

A

Current inhalers (also confirm the technique)
Beta-blockers, aspirin, and NSAIDs (Non-steroidal anti-inflammatory drugs)
Effect of previous drugs/inhalers.

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16
Q

What are important questions to ask in the family history?

A

Asthma and other atopic disease.

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17
Q

What are important questions to ask in the social history?

A

Tobacco, recreational drugs, vaping
Pets
Occupation
Psychological aspects

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18
Q

What might be helpful to do in an clinical examination for asthma?

A

Breathless on exertion
Hyperinflated chest
Wheeze

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19
Q

What signs might be present if it isn’t asthma?

A

Finger clubbing, Stridor, Asymmetrical expansion, dull percussion note, cervical lymphadenopathy (lymph nodes in the neck)

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20
Q

If it isnt asthma, what could it be?

A
  • Generalised airflow obstruction (COPD (Irreversible AFO), Bronchiectasis, Cystic Fibrosis
  • Localised airway obstruction: Tumour and foreign body
  • Cardiac
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21
Q

What is a good test to differentiate between asthma and COPD?

A

Full pulmonary function testing

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22
Q

What is reversibility testing?

A

This is when the FEV1 is measured before and 15 minutes after a dose of salbutamol (inhaled or nebulized).

Response to oral corticosteroids is checked after 2 weeks.

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23
Q

What 3 chemicals are used to measure airway responsiveness?

A

Methacholine, Histamine, exhaled nitric oxide and Mannitol

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24
Q

What are other useful investigations for asthma?

A

Chest X-Ray (hyperlucent or hyperinflated)
Skin prick testing
Total and specific IgE
Full blood count

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25
Q

How do we assess how severe acute asthma is?

A
  • Ability to speak
  • Heart rate
  • Respiratory rate
  • PEF
  • Oxygen saturation / Arterial blood gases
26
Q

What symptoms are present in moderate asthma?

A

Able to speak and complete sentences, HR < 110, RR < 25, PEF (Peak expiratory flow) 50 - 75%

27
Q

What symptoms are present in severe asthma?

A

Inability to complete sentences in one breath, HR > 110, RR > 25, PEF 33 - 50%

28
Q

What symptoms are present in life-threatening asthma?

A

Grunting, impaired consciousness, confusion, exhaustion, bradycardia, arrhythmia, hypotension, PEF < 33%, silent chest

29
Q

What are the main symptoms of near fatal asthma?

A

Raised PaCO2 and need for mechanical ventilation.

30
Q

What causes the airways to be inflamed?

A

Immune system

31
Q

What is the prevalence of asthma?

A

Children 10-15% M > F, Adults 5 - 10% F > M

32
Q

What are the genetic risk factors for asthma?

A

Atopy
Inherited tendency to IgE response to allergens. Asthma, eczema, hayfever, food allergy Markers, skin prick tests, IgE. Strongest risk factor: personal, familial atopic tendency - Maternal atopy most influential

33
Q

What allergens can occupation expose you to?

A

Isocyanates (paints), Colophony (welding solder flux), Laboratry Animals, Grains, Enzymes, Drugs, Crustaceans

34
Q

What are essential investigation for asthma diagnosis?

A

Airflow obstruction Variability and reversibility of airflow obstruction

35
Q

What is the effect of maternal smoking on FEV1?

A

FEV1 is reduced.

36
Q

What is the effect of maternal smoking on Wheezy illness, airway responsiveness, asthma and severity?

A

All increase

37
Q

What is the grandmother effect?

A

Grandchildren are far more likely to suffer from asthma if their grandmothers smoked while pregnant.

38
Q

What is body mass index positively associated with?

A

Asthma, Wheezing, airway hyperactivity

39
Q

Which diet substances affect risk of asthma?

A

Decrease in anti oxidants and N-3 polyunsaturated fatty acids = risk factor. Increase in N-6 polyunsaturated fatty aids = risk factor. Too much or too little vitamin D

40
Q

Give an example of microbial products.

A

Endotoxin, glucans, extrascapular polysaccharide. Microbial diversity also important in redusing risk of asthma and allergy.

41
Q

Which indoor cleaning products have an increased risk of causing cancer?

A

Volatile organic compounds, Formaldehyde, Fragrances.

42
Q

What feature of the dust mite is allergenic?

A

Protease in droppings.

43
Q

What influence does affluence have on allergens?

A

Increases the likelihood of sensitisation to local allergens

44
Q

What is the most important consideration when making an asthma diagnosis?

A

HISTORY

45
Q

What common health conditions are important to consider when diagnosing asthma?

A

Childhood asthma, bronchitis, eczema, hayfever and eczema are other atopic conditions

46
Q

What are the two positive findings for asthma?

A

Airflow obstruction, variability and or reversibility of airflow obstruction.

47
Q

How can you determine if someone has obstructed airways?

A

FEV1 is less than 80% predicted and FEV1/FVC ratio<70%

48
Q
  • What do FEV1 and FVC tell us respectively?
A

Airway diameter and lung capacity

49
Q

After confirmation of obstructed airways, what is your next step in the diagnosis of asthma?

A

Full pulmonary function tests, confirmation of reversibility with B2 agonists and steroids

49
Q

After confirmation of obstructed airways, what is your next step in the diagnosis of asthma?

A

Full pulmonary function tests, confirmation of reversibility with B2 agonists and steroids

50
Q

If airways are not obstructed what is your next step in diagnosis?

A

Peak flow monitoring, Bronchial provocation with nitric oxide

51
Q

What is a bronchial provocation test?

A

Evaluates how sensitive the airways in your lungs are.The spirometry results are compared before and after you inhale a spray to see what changes there are in your breathing. Spray is usually metyhacholine.

52
Q

What are the tests involved in the full pulmonary function testing?

A

Lung volumes, Carbon monoxide gas transfer.

53
Q

What is gas trapping?

A

Abnormal retention of air in thelungswhere it is difficult to exhale completely. Observed inobstructive lung diseasessuch asasthma, bronchiolitis obliterans syndrome andchronic obstructive pulmonary diseasessuch asemphysemaandchronic bronchitis.

54
Q

How is lung residual volume measured of the lungs?

A

Helium dilution technique: The patient inhales breaths of helium and oxygen in a closed system. Concentration of helium will decrease as it diffuses into all areas of the lung. The amount of concentration reduction it indicative of the residual capacity

55
Q

What is the residual volume and total lung capacity of a patient who is asthmatic?

A

Increased residual volume, increased total lung capacity.

56
Q

What is the carbon monoxide gas transfer used to determine?

A

Ability of gas transport across the alveoli, alveoli are unaffected in asthma it is only the airway that are affected.

57
Q

When spirometry is normal why is it important to measure peak flow?

A

Looking for variability in airflow obstruction. Lung function in clinic may(usually) be normal

58
Q

What test is likely to increase use of according to NICE?

A

Exhaled nitric oxide tests

59
Q

How would you read the methacholine responsiveness?

A

Reduction of FEV1 by over 20%

60
Q

What is the effect of methacholine?

A

Acts like acetylcholine to constrict airways. Nebulising the substance you think they are susceptible to can be useful too.

61
Q

What is the exhaled nitric oxide in an asthmatic patient compared to normal?

A

Increase in nitric oxide

Respiratory System & CVS Physiology Year 1 (58 decks)

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