PBL 5: Tracy Sinclair

Question 1

What are the 3 characteristics of asthma?

Answer 1

• hypersecretion of the mucous glands
• bronchodilation of the airways
• inflammation of the airways and oedema

Question 2

What are some features of asthma?

Answer 2

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

Question 3

What can trigger asthma?

Answer 3

Exposure to certain things:
airborne irritants/pollutants
medications
foods
dust/fungal spores
animal feces
pollen
cold air
exercise

Question 4

What is asthma closely associated with?

Answer 4

Atopic triad - hayfever and eczema

Allergic - IgE mediated

Question 5

What is the hygiene hypothesis?

Answer 5

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

Question 6

What are the risk factors of asthma?

Answer 6

Smoking
Young age
Clean environment? - hygiene hypothesis
Intake of illegal substances - emphysema

Question 7

What are the 2 main types of treatment for asthma?

Answer 7

Bronchodilators

Anti-inflammatories

Question 8

What are the main bronchodilators?

Answer 8

Beta -2 agonists
Anti-muscarinics
Phosphodiesterase inhibitors

Question 9

What are the types of beta-2-agonists and what do they do?

Answer 9

Salbutamol - short acting, relieves symptoms

Formeterol - long acting, preventer

Question 10

What do anti-muscarinics do and what are some examples?

Answer 10

Antagonise M3 receptors to inhibit PS effect of acetylcholine inhibiting mucus hypersecretion
Ipratropium, Tiatropium

Question 11

What are some examples of phosphodiesterase inhibitors and what do they do?

Answer 11

Aminophylline, theophylline

Inhibit bronchoconstriction, hypersecretion of mucus and inflammation

Question 12

What are the different anti-inflammatories?

Answer 12

Corticosteroids
Leukotriene antagonists
Anti-IgE antibodies

Question 13

What do corticosteroids do? What are some examples?

Answer 13

Bexamethosone diproprionate

Beta-2-agonist expression

Question 14

What are some other asthma medications and procedures?

Answer 14

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

Question 15

What advice should be given to Tracy?

Answer 15

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

Question 16

What are signs of severe asthma?

Answer 16

Low SaO2
Tachycardia
Hypoxia

Question 17

What is life threatening asthma?

Answer 17

PaO2<8Kpa, tachycardia, SaO2 <92%, silent chest, cyanosis, weak resp effort

Question 18

What is acute severe asthma?

Answer 18

HR > 110, resp rate >25/min, PEFR <35%, inability to complete sentences in 1 breath

Question 19

What stage of asthma does Tracy fit?

Answer 19

Between severe and life threatening so treated immediately and admitted to hospital

Question 20

What is the significance of aspergillus fumigatus?

Answer 20

Antibodies specifically of a class associated with mould - indicative of a mould allergy and this being trigger/cause of asthma

Question 21

What type of respiratory failure does Tracy have?

Answer 21

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

Question 22

What is the effect of her hypocapnia?

Answer 22

High pH - respiratory alkalosis