RESP - A. DIAGNOSIS AND TREATMENT OF ASTHMA-COVERED Flashcards
asthma
- long term long condition
more than 1 of:
- wheeze
- breathlessness
- chest tightness
- cough
- variable airflow obstruction
- airway hyper-responsiveness: exaggerated tightening of airways
- airway inflammation
symptoms of an asthma attack
- wheeze
- breathlessness
- chest tightness
- cough
- reliver inhaler isn’t helping
- can’t eat, sleep or speak due to breatlessness
- breathing getting faster
- children: tummy ache or hurting chest
key facts about asthma
- 12% UK population has asthma
- occupational asthma may account for 10% adult-onset asthma
- 3 people die daily from having an asthma attack
- someone has a life-threatening attack every 10 seconds
- children <2 with asthma are symptoms free by 6-11
causes of asthma
- genetics
- atopic conditions (hay fever, eczema)
- prematurity, bronchiolitis, croup
- female hormones (more boys have until puberty then girls 2x as likely)
- occupation - exposed chemical, dust
- smoking (+ during pregnancy)
- pollution
- obesity
diagnosing asthma
- symptoms AND result of at least 1 diagnostic test
Adults
1. FeNO - fractional exhaled NO testing
2. spirometry
Children
1. spirometry
2. FeNO
- onset?
- triggers? (pet fur, cold to warm air, emotions in children)
- occupation
- personal and family history of atopic conditions?
- expiratory polyphonic wheeze:
continuous whistling sound produced in airways during breathing
different pitches and tones over areas of lungs when breathing out
spirometry
- measures FEV1 and FVC. look at FEV1/FVC ratio
- ratio <70% - asthma? but look at bronchodilator reversibility too
- for diagnosis: bronchodilator reversibility >12% increase in FEV1 (spirometry, give salbutamol, leave 20 minutes, spirometry again)
Adults
- look at volume aswell
- look for a difference in at least 200ml in FVC
- >400ml = asthma
Children
- look at differences in FEV1 alone
fractional exhaled NO testing
- breathe into hand-held machine
- measures amount of exhaled NO in breath
- higher level: inflam of airways, flare?
- can’t smoke for an hour before, alcohol, caffeine
- +ve test is >40ppb
peak flow variability
- patients can monitor at home
- can indicate flares and worsening of symptoms
what is the aim of asthma treatment
to control it NO:
- daytime symptoms
- nighttime awakening
- need for rescue medication
- attacks
- limitations ie - exercise
- normal lung function
- minimal side effects from medication
non-pharmacological treatments for asthma
- avoid allergens
- smoking cessation
- weight loss
- breathing exercises
- pulmonary rehabilitation
- managing anxiety/depression
- relaxation techniques
where to signpost people to
- Asthma and Lung UK
- everyone should have an asthma action plan
what are the different types of asthma medication
- reliever inhalers
SABA eg - salbutamol (blue)
SAMA - used more for COPD - preventer inhalers
inhaler corticosteroid (reduce inflam in airways and hence obstruction so need to use every day) - combination therapy inhalers
MART - oral medicines
LTRA
Theophylline (specialist use) - biologics
short acting beta2 agonists
- salbutamol
- very fast
- asthma and COPD
- relaxes smooth muscle and bronchodilates
- reduces breathlessness
side effects:
- tachycardia
- tremor
- muscle cramp
- hypokalaemia
long acting beta2 agonists
- salmeterol, formoterol
- not used as monotherapy
- completely same as SABA
short acting muscarinic antagonists
- ipratropium
- asthma attacks and COPD
- antagonises ACh-mediated bronchospasm and relaxes smooth muscle
- reduces breathlessness
side effects:
- dry mouth
- dizziness
- blurred vision
- nausea
- arrhythmias
