Kapitel 25

Question 1

Definition på astma?

Answer 1

Asthma is a chronic inflammatory disorder of the airways in which many cells and cellular elements play a role.

Kronisk inflammation: Airway hyperresponsiveness

Variable, airway obstruction

Question 2

Symptomer på astma?

Answer 2

• Wheezing
• Breathlessness
• Cough
• Chest tightness

Question 3

Disease characteristics of astma?

Answer 3

Obstructive pattern, but reversible

Variability: Between subjects and within subjects

Episodic symptoms that disappers spontaneously or after treatment

Question 4

Faktorer for at udvikle astma?

Answer 4

Host factors: Genetic, obesity, sex

Enviomental: Allergens, infections, occupational sensitizers, tobacco smoking, diet

Question 5

How to diagnose asthma?

Answer 5

På baggrund af symptomer
Concurrent atopic disease såsom atopic dermatitis.
Genetic pre-disposition

Objective tests: Spirometri, Peak expiratory flow, chest x-ray, blodprøver.

Question 6

Measurement of the lung funktion?

Answer 6

FEV1 = Forced ex. volume in one second
FVC = forced vital capacity

FEV1/FVC

Reversibilitet hvis astma ved behandling med b2-agonist

Question 7

Beskriv flowchart over astma diagnostik

Answer 7

-Først vurderes symptomer.

Efter spirometri (FEV1/FVC) er der 2 muligheder alt efter hvad denne viste. 
Hvis FEV1 > 85 % og FEV1/FVC > 0.7 kan der udføres provokationstest. Hvis denne er positiv --> ASTMA. 

Hvis lungefunktion er dårlig –> Beta-2 reversibilitetstest. Hvis stor reversibilitet –> ASTMA. Hvis lav reversibilitet –> KOL.

Question 8

Hvordan skelnes astma og COPD nemt?

Answer 8

ASTMA:
Debut i ung alder. % ryger, er i familien, har rihinitis,

COPD: Often > 40 yeras, har røget i mange år, IKKE RHINITIS, Ikke reversible lungefunktion

Question 9

Behandling af astma?

Answer 9

Medicinering, reducere risikofaktorer, education, monitoring

Question 10

Hvad inddeles level of asthma control i? (GINA inddeling)

Answer 10

Controlled (under 2 symptomer pr. uge
Partly controlled (mindsket lungefunktion. Over 2 daytime symptoms pr. uge)
Uncomtrolled (over 3 daytime symptoms pr. uge)

Question 11

Hvordan indeles asthma treatment medication?

Answer 11

Reliever medication (kort-tidsvirkende B2-agonister, inhaled anticholinergics)

Controller medication (glucocorticoider, leukotrine modifers, lang-tidsvirkende B2 agonister. Anti-IgE, immunotherapy)

Question 12

Hvordan virker reliever medications?

Answer 12

Work on B2-receptor, relief bronchospasms.

Side effecs: Tremor (rystelser), tachycardia

Question 13

Hvordan virker inhaled corticosteorids?

Answer 13

Har antiinflammatory effect. Eks. på lm: Spirocort.

BIVIRKNING: Decreased bone mineral density.

Question 14

Hvordan virker leukotriene modifiers?

Answer 14

Leukotrienes are important mediators in inflammatory responses.

Question 15

Reasons for lack of compliance?

Answer 15

Symptoms have disappeared
Inhalers are empty
Side effects
Don’t see themselves as ill

Question 16

Treatment of asthma exacerbations?

Answer 16

O2!

Akut: Bronchodilators (beta-2, anti-cholinergics) systemic glucocorticoids. ANDRE: antibiotika, systemisk b2-agonist.

Question 17

Behandlingsstrategi

Answer 17

1. MILD ASTHMA
   SABA (short-acting beta2 agonist)
2. REGULAR PREVENTER THERAPY
   add inhaled steorid to SABA
3. ADD-ON THERAPY
   add LABA, assess control of astma, er der benefit af LABA?
4. PERSISTENT POOR CONTROL
   Øg dosis af inhaled steroids. add 4. drug såsom b2-tablet, leukotriene receptor antagonist.
5. CONTINUOUS OR FREQUENT USE OF RAL STEROIDS
   overvej alternativ –> specialist.

Question 18

Hvordan kan en patient selv måle lungefunktion?

Answer 18

Med et peak flow meter.

PEF: Peak expiratory flow, used to assess the improvement.