Respiratory 4 - Asthma Flashcards
define asthma
bronchoconstriction triggered by airway hypersensitivity
causes reversible airway obstruction
6 typical asthma triggers
infection night time/early morning exercise animals cold,damp,dust strong emotions
6 presenting factors suggesting asthma
episodic in nature diurnal and worse at night dry cough, wheeze, SOB atopic Hx (x3) FH bilateral polyphonic wheeze
5 aspects suggesting a diagnosis other than asthma
recent cough/cold - viral induced isolated/productive cough normal inv no response to treatment unilateral wheeze
2 first line investigations for asthma + 2 other options if still uncertain
fractional exhaled NO
spirometry + reversibility testing
peak flow diary
bronchial challenge test with histamine
give 7 drugs involved in long term asthma treatment
SABA salbutamol ICS beclometasone LABA salmeterol LAMA tiotropium LTRA montelukast theophylline MART (ICS + fast LABA)
give the NICE stepwise asthma ladder 8 steps
- SABA reliever therapy
- add low dose ICS
- add montelukast
- add LABA inhaler (discontinue if poor response)
- consider switch to MART
- increase ICS to moderate
- 3 options: high dose ICS / oral theophylline / inhaled LAMA (tiotropium)
- specialist input
2 yearly things for asthma patients
yearly asthma review and flu jab
5 presenting features of acute asthma attack
progressively worsening SOB accessory muscles fast resp rate symmetrical expiratory wheeze tight chest, reduced entry
define moderate, severe + 5 aspects of life-threatening asthma
mod - PEFR 50-75% of normal
severe - PEFR 33-50% =, can’t complete sentences
life-threatening:
- PEFR <33%
- sats <92%
- tiring
- silent chest / no wheeze
- evidence of shock
4 treatment steps for moderate asthma attack
salbutamol 5mg nebs PRN
nebulised ipratropium
oral pred or IV hydrocort
consider Abx if evidence of infection
3 extra treatment steps in severe asthma attack
oxygen to maintain sats 94+
aminophylline infusion
consider IV salbutamol
senior input
3 extra treatment steps in deadly asthma attack
IV mag sulphate
ITU / HDU
intubate early
senior input
describe ABG patterns in asthma
start with resp alkalosis as tachypnoea drops CO2
normal CO2 / hypoxia very worrying as tiring
resp acidosis is a very very bad sign
5 monitoring steps in asthma attack
resp rate resp effort peak flow o2 sats ausc chest
