PBL 5: Tracy Sinclair Flashcards
What are the 3 characteristics of asthma?
- hypersecretion of the mucous glands
- bronchodilation of the airways
- inflammation of the airways and oedema
What are some features of asthma?
Reversible Relieved with bronchodilators Reduced peak flow Reduced FEV1/FVC Large IgE mediated response Eosinophils in the bronchial wall releasing histamines, leukotrienes and pro-inflammatory cytokines
What can trigger asthma?
Exposure to certain things: airborne irritants/pollutants medications foods dust/fungal spores animal feces pollen cold air exercise
What is asthma closely associated with?
Atopic triad - hayfever and eczema
Allergic - IgE mediated
What is the hygiene hypothesis?
Theory where clean tidy environments and households can increase the prevalence of allergies and asthma and those who come from less clean environments where there may be more dust for example tend to have lower incidences
What are the risk factors of asthma?
Smoking
Young age
Clean environment? - hygiene hypothesis
Intake of illegal substances - emphysema
What are the 2 main types of treatment for asthma?
Bronchodilators
Anti-inflammatories
What are the main bronchodilators?
Beta -2 agonists
Anti-muscarinics
Phosphodiesterase inhibitors
What are the types of beta-2-agonists and what do they do?
Salbutamol - short acting, relieves symptoms
Formeterol - long acting, preventer
What do anti-muscarinics do and what are some examples?
Antagonise M3 receptors to inhibit PS effect of acetylcholine inhibiting mucus hypersecretion
Ipratropium, Tiatropium
What are some examples of phosphodiesterase inhibitors and what do they do?
Aminophylline, theophylline
Inhibit bronchoconstriction, hypersecretion of mucus and inflammation
What are the different anti-inflammatories?
Corticosteroids
Leukotriene antagonists
Anti-IgE antibodies
What do corticosteroids do? What are some examples?
Bexamethosone diproprionate
Beta-2-agonist expression
What are some other asthma medications and procedures?
IV magnesium to reduce SM contractility
Monoclonal antibodies to reduce expression IgE receptors
Thermoplasty to reduce bronchial wall thickness through heat induced damage to the wall
What advice should be given to Tracy?
Stop smoking and how
Give own peak flow meter to monitor her own
Book asthma clinical appointment so can assess what her potential causes and triggers are
What are signs of severe asthma?
Low SaO2
Tachycardia
Hypoxia
What is life threatening asthma?
PaO2<8Kpa, tachycardia, SaO2 <92%, silent chest, cyanosis, weak resp effort
What is acute severe asthma?
HR > 110, resp rate >25/min, PEFR <35%, inability to complete sentences in 1 breath
What stage of asthma does Tracy fit?
Between severe and life threatening so treated immediately and admitted to hospital
What is the significance of aspergillus fumigatus?
Antibodies specifically of a class associated with mould - indicative of a mould allergy and this being trigger/cause of asthma
What type of respiratory failure does Tracy have?
Type 1 as her oxygen levels are low but her carbon dioxide levels are low so not hypercapnia but hypocapnia
May develop Type 2 if conditions worsens
What is the effect of her hypocapnia?
High pH - respiratory alkalosis
