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Pathophysiology > Respiratory Diseases - Asthma > Flashcards

Respiratory Diseases - Asthma Flashcards

1
Q

What is the definition of Asthma?

A
  • respiratory condition marked by attacks of spasm in the bronchi of the lungs
  • causes difficulty breathing
  • usually connected to allergic reaction or other forms of hypersensitivity
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2
Q

What is the pathophysiology of Ashtma?

A

3 factors:

  • mucosal swelling/inflammation caused by mast cell and basophil degranulation => prostaglandins, cysteinyl leukotrienes, histamine and other inflammatory mediators
  • mucus formation
  • bronchial muscle contraction
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3
Q

What are the typical triggers of Asthma?

A
  • dust (house dust mites)
  • animals
  • cold air
  • exercise
  • smoke
  • food allergens (e.g. peanuts, shellfish or eggs)
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4
Q

What are the respiratory cardinal questions?

A
  • Chest Pain
  • Dyspnea (difficulty breathing)
  • Cough
  • Wheezing
  • Expectoration (sputum)
  • Hemoptysis (coughing up blood)
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5
Q

What are the signs and symptoms of Asthma?

A
  • wheezing
  • breathlessness
  • tight chest - may feel like a band is tightening around it
  • coughing
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6
Q

When is it more likely symptoms are asthma?

A
  • happen often and keep coming back
  • are worse at night/early morning (cortisol/melatonin high)
  • seem to happen in response to asthma trigger like exercise or allergy (pollen/animal fur)
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7
Q

How can you explore your suspicions of Asthma?

A
  • Case Hx
  • check for wheeze/cough or breathlessness
  • daily or seasonal variations in cough
  • any triggers that make symptoms worse
  • personal or family history of atopic disorders
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8
Q

What are the severe symptoms of Asthma that need emergency medical attention?

A
  • wheezing, coughing and chest tightness becoming severe and constant
  • being too breathless to eat, speak or sleep
  • breathing faster
  • a fast heartbeat
  • drowsiness, confusion, exhaustion or dizziness
  • blue lips or fingers
  • fainting
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9
Q

What might you observe in someone with asthma?

A
  • may result in barrel chest with indrawn costal margins
  • increased breathing
  • cyanosis
  • cough
  • audible wheeze/polyphonic
  • peripheries: fine tremor from salbutamol use
  • tachycardia
  • oral candidiasis (steroid inhaler use)
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10
Q

What might you see in an asthma physical examination?

A
  • polyphonic wheeze
  • use of accessory muscles
  • headaches
  • neck pain
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11
Q

What is a polyphonic wheeze?

A
  • continuous, whistling sound produced in the airways during breathing
  • caused by narrowing or obstruction in the airway
  • multiple pitches and tones heard over different areas of the lung when the PT breaths out
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12
Q

What other tests are available for asthma?

A
  • FeNO test (fractional exhaled nitric oxide) = measures level of nitric oxide in breath (sign of inflammation in lungs)
  • spirometry - measures how fast you can breathe out and how much air you can hold in your lungs
  • peak flow test - measures how fast you can breathe out (less reliable)
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13
Q

What treatments are available for Asthma?

A
  • salbutamol - B2 adrenoreceptor; relaxes smooth muscle; acts within minutes
  • beclomethasone - corticosteroid; reduces bronchial mucous inflammation; acts over days
  • personalised asthma plan (GP/nurse) -> daily treatment, treatment escalation in exacerbation, when to seek help, PEFR diary
  • asthma review to be carried out annually (GP/nurse) e.g. symptoms, control, smoking, inhaler technique, adherence, PEFR and vaccination status
  • vaccines updated e.g. pneumococcal and flu
  • lifestyle measures e.g. smoking cessation, weight loss, asthma triggers avoided
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14
Q

What types of asthma are there?

A
  • adult onset asthma
  • allergic asthma
  • asthma-COPD overlap
  • exercise-induce bronchoconstriction (EIB)
  • nonallergic asthma
  • occupational asthma
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15
Q

Case History:

Jared is a 48 yo computer based manager at a local insurance company. He enjoys an active life playing golf at weekends and going to the gym 3 x a week and socialising with friends.

What might us consider the respiratory system in Jared’s case Hx?

A
  • history of respiratory disease
  • changes in skin colour e.g. flushed, bluish
  • sleeping pattern e.g. sleep apnea, dyspnea
  • SOB
  • history of smoking
  • history of atopic diseases e.g. eczema
  • history of allergies
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16
Q

Case History:

Jared’s past history is unremarkable except for a history of childhood asthma from 5-15 years. Since then he has noticed hayfever for a month every year in early summer and a tendency for colds to become chest infections easily. Last winter he felt he was ill with coughs and colds for most of the winter.

What differential diagnosis might you consider for Jared?

A
  • COPD if previously a smoker (bronchitis) due to chest infections, would ask about cough (mucus producing, colour, smell), whether it was difficult to breath in, longer exhale than inhale
  • pneumonia as ill over winter, especially if alcoholic, would ask about attending hospital recently, scoliosis, sputum, type of cough (dry/mucus producing)
  • asthma as had asthma as a child and an allergy, repetitive
17
Q

What is the difference between Asthma and COPD?

A
  • asthma and COPD can be difficult to distinguish clinically and may co-exist
  • COPD: productive cough and dyspnoea on exertion in a person over 35 years of age who is a current or previous smoker
  • asthma is fully reversible airway narrowing
  • COPD is not fully reversible airway narrowing
18
Q

What are other Differential Diagnosis for asthma?

A
  • gastro-oesophageal reflux - clinal features include cough, postural and food-related symptoms and vomiting
  • COPD
  • pulmonary embolism
  • TB
  • cystic fibrosis
  • heart failure - clinical features include orthopnoea (shortness of breath when lying flat), oedema, a history of ischaemic heart disease and fine lung crepitations
  • chronic sinusitis
  • allergic rhinitis
  • foreign body inhalation
  • vocal cord dysfunction
  • foreign body aspiration - suggested by sudden onset cough, stridor (upper airway) or reduced chest wall movement on the affected side, bronchial breathing and reduced of diminished breath sounds (lower airway)
  • bronchiectasis
  • lung cancer
19
Q

What are the red flags of a severe/acute asthma?

A
  • foster collapse position in endurance runners (recovery position + ambo)
  • unable to complete sentences
  • pulse > 110bpm
  • respiration > 25 breaths per min
  • peak flow < 50% predicted or best
  • use of accessory muscles
  • chest can sound tight on auscultation with reduced air entry
20
Q

What are the signs of a life threatening asthma attack?

A
  • silent chest
  • cyanosis
  • bradycardia (<60bpm)
  • exhaustion
  • peak flow <33% predicted or best
21
Q

What are the non-modifiable risk factors for asthma?

A
  • personal or family history of atopy
  • male sex (asthma development) or female sex (persistence to adulthood)
  • prematurity and low birth-weight
  • another allergic reaction e.g. hay fever
22
Q

What are the modifiable risk factors of asthma?

A
  • smoking
  • occupational dust e.g. pollutants, chemicals in farming/hairdressing
  • obesity
  • social deprivation
  • infections in infancy
  • emotional triggers
23
Q

What osteopathic case history questions would you ask for asthma?

A
  • occupation - what does your job entail?
  • family history
  • childhood diseases
  • are you generally well?
  • check for wheeze/breathlessness
  • daily/seasonal pattern of symptoms
  • triggers that make it worse
  • family or personal history
24
Q

What might you physical examinations would you do for asthma?

A
  • check hands - blue + warm = respiratory/blue + cold = cardiovascular
  • respiratory examination - looking for polyphonic wheeze over lobes

Pathophysiology (12 decks)

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