Clinical Features of Asthma in Adults Flashcards
Asthma leads to what two things happening in the body?
Widespread narrowing of airways
Increased airway reactivity
What can increased airway reactivity lead to?
Airways narrowing- either in response to stimuli or occurring spontaneously.
What is atopy?
The body’s predisposition to develop an antibody called IgE (immunoglobulin E) in response to exposure to environmental allergens.
It is a inheritable trait.
Give some examples of atopic diseases.
Allergic rhinitis, asthma, hay fever and eczema.
What increases the risk of asthma?
If a first degree family member has asthma or another atopic disease.
Why does smoking while pregnant increase the child’s chances of having asthma?
It decreases the child’s FEV1
Increases the likelihood of wheezy illness
Increases airway responsiveness
Describe epigenetic phenomena in terms of risks of asthma due to smoking in previous generations.
Even if your grandmother smoked, it still increases your chances of developing asthma as the environmental trigger of tobacco switches on genes which increase chances of asthma.
What is occupational asthma caused by?
Exposure to different allergens and their effects.
Name three jobs were occupational asthma is more likely to occur.
Baker
Builder
Shellfish workers
What is the most important clinical part when diagnosing someone w asthma?
Their history
What are the main symptoms of those with asthma?
Wheeze
Cough
Chest tightness
Breathlessness
What colour can sputum brought up by asthmatic patients be?
Green or yellow but important to note that this doesn’t always mean there is a viral or bacterial infection.
Discuss variation of asthma throughout the day.
Symptoms may be worse or better at night or early morning
Discuss weekly variation of asthma.
May be different at the weekends
May vary depend on occupation
May be better on holidays
Discuss annual variation of asthma.
Asthma may be better/worse at certain times of the year.
List some of the different trigger for individuals with cancer (differ in every individual).
Exercise
Cold air
Cigarette smoke
Perfumes/strong scents
Pets
Tree/grass pollen
Drugs
Foods
In the diagnosis of asthma in adults, what is one thing you should ask about in past medical history?
Childhood asthma/hay fever/ eczema/ wheeze etc.
In the diagnosis of asthma in adults, what is one thing you should ask about in drugs and medication?
If they are on any of the following-
-Inhalers
-Beta blockers
-Aspirin
Double check what the effects were of the previous drugs listed.
In the diagnosis of asthma in adults, what is one thing you should ask about in family medical history?
If any family members have a history of asthma/related diseases.
In the diagnosis of asthma in adults, what is one thing you should ask about in social history?
Smoking
Pets
Occupation, past and present
Psychological aspects- e.g. stress makes asthma worse
Clinical examination is not always helpful in diagnosis of asthma but what should you look out for?
Breathlessness on excretion
Wheeze
Hyperinflated chest
List some symptoms which may indicate that the patient does not have asthma.
Finger clubbing
Stridor (high-pitched, turbulent sound on inhale and exhale)
Asymmetrical expansion, dull percussion note
Crepitations
List some other causes of wheezing/breathlessness/cough.
Generalised airflow obstruction
-COPD (irreversible AFO)
-Bronchiectasis
-Cystic Fibrosis
Localised airway obstruction (inspiratory stridor= large airways)
-Tumour
-Foreign body
Cardiac
Which evidence may you be looking for in investigations if you’re not sure if a patient has asthma or not?
Airflow obstruction
Variability and/ or reversibility of airflow obstruction
What is the main test used to help come up with a diagnosis of asthma?
Spirometry
Which tests may you perform if there is a obstructed spirometry i.e. FEV1/FVC<70%,
FEV1<80% predicted
Full pulmonary function tests
Reversibility tests
What happens in full pulmonary function testing?
Gas transfer test which measures the gas transfer of carbon monoxide to haemoglobin.
Which two respiratory conditions can full pulmonary function testing be useful to differentiate?
Asthma and COPD
What happens in reversibility to bronchodilator?
Check the FEV1 before and after for 15 minutes after either inhaled or nebulized dose of salbutamol to look for improvement
Significant improvement is consistent with asthma
When investigating the variability of airway obstruction, how often are patients asked to measure their peak flow?
Twice daily for two weeks
Name three chemicals a patient might be asked to breathe in as part of an airways responsiveness test.
Methacholine
Histamine
Mannitol
What would be looked out for when doing chest xrays when concerned about asthma?
Hyperinflated, hyperlucent lung fields.
What other causes of symptoms of a chest x-ray when concerned about asthma would need to be excluded?
No effusion, collapse, opacities, interstitial changes
What does skin pricking tell us about those who are suspected to have asthma?
Their atopic status.
What total and specific IgE tell us about those who are suspected to have asthma?
Their atopic status
What are the four rankings of asthma attack.
Moderate
Severe
Life threatening
Near fatal
In those with moderate asthma, what is their speaking ability like?
Able to speak in complete sentences
In those with moderate asthma, what is their HR like?
<110
In those with moderate asthma, what is their RR like?
<25 b/m
In those with moderate asthma, what is their PEF like?
50-75% predicted or best
In those with moderate asthma, what is their oxygen saturation?
92% or more
In those with moderate asthma, what is their arterial pressure of oxygen be?
> 8kPa
In those with severe asthma, what is their speaking ability like?
Unable to complete a sentence in one breath
In those with severe asthma, what is their HR?
> 110
In those with severe asthma, what is their RR?
> 25
In those with severe asthma, what is their PEF?
33-50% predicted or best
In those with severe asthma, what is their oxygen saturation?
92% or more
In those with severe asthma, what is their arterial partial pressure of oxygen?
> 8kPa
Name some of the symptoms that if a patient has at least one, it is classified as life threatening asthma.
Grunting
Impaired consciousness, confusion, exhaustion
Bradycardia/ arrhythmia/ hypotension
PEF < 33% predicted or best
Cyanosis
Silent chest
Poor respiratory effort
SaO2 < 92% (definitely needs blood gas!)
PaO2 < 8kPa
PaCO2 normal (4.6 - 6.0kPa)
Name two symptoms in which the asthma is classified as near fatal.
Raised PaCO2
Need for mechanical ventilation
