Respiratory Medicine 2 - Asthma Flashcards
Give a brief overview of asthma:
Asthma is a reversible small airway (bronchiole) obstruction
- affects all ages
- increasingly common
- inflammatory and allergic condition
- often benign but can be life threatening
Name some symptoms of Asthma:
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What can induce these symptoms?
- wheeze/chest tightness
- breathlessness (not always directly related to exercise)
- cough
- trigger by cold
- emotion
- nocturnal
- exercise
What is used to assess/monitor asthma on a day to day basis?
Peak expiratory flow rate:
- standardised recording technique
- classically poorer in mornings - diurnal variation (as are symptoms)
Name the common precipitants of asthma:
- Allergens: pollen, dust mites, pet dander
- Irritants: dust, smoke
- Exertion
- NSAIDs
- Emotion
Name the indicators of increased severity:
- restriction of activities
- worsening symptoms
- frequent inhaler use, particularly the reliever (SABA)
- use of LAMA, montelukast, theophylline, oral corticosteroids, monoclonal antibody treatment
- peak flow readings
List the peak flow results and their corresponding categories:
- Moderate acute asthma = PEFR 50-75% of best or predicted
- Acute severe asthma = PEFR 33-50%
- Life threatening asthma = PEFR less than 33%
List the markers for moderate acute asthma and the treatment for it:
Moderate acute asthma:
- increasing symptoms
- PEFR > 50-75% best or predicted
- no features of acute severe asthma
Give salbutamol and reassess
List the markers for acute severe asthma and what to do:
Any one of the following indicates acute severe asthma:
- PEFR 33-50% best or predicted
- respiratory rate >25 breaths per minute
- heart rate > 110bpm
- inability to complete sentences in 1 breath
Phone 999, give salbutamol, give oxygen
What are the signs of life-threatening asthma? What would you do in this situation?
Any one of the following signs in a patient with severe asthma indicates life-threatening asthma:
- exhaustion
- altered conscious level
- arrhythmia
- hypotension
- cyanosis
- silent chest
- poor respiratory effort
Phone 999. give salbutamol, give oxygen
How would you treat acute asthma in the surgery?
What would you do if the patient did not satisfactorily respond to the first step?
What should you administer if the attack is part of an anaphylactic reaction?
- ABCDE approach
- Give salbutamol inhaler: 2 puffs with spacer
If patient did not satisfactorily respond:
- Phone 999, give high flow oxygen, salbutamol 5mg nebuliser or 2-10 puffs via spacer
- send someone for AED
- Repeat salbutamol every 10 minutes
If part of an anaphylactic reaction, give IM adrenaline (0.5mg for adult)
Why may a patient be presenting with unstable asthma?
What are the signs of unstable asthma?
How may unstable angina be managed by the GP?
Unstable asthma may be due to:
- recent infections
- poor compliance
Signs of unstable asthma include:
- using SABA inhaler more frequently
- reduced exercise limit
Management by GP:
- short course of oral steroids
- alteration to regular inhalers if gradual worsening
What type of drug should you avoid prescribing to asthmatics?
List some oral side effects of inhaled therapy:
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Do not prescribe NSAIDs - can induce bronchospasm in a person with asthma and it may be severe
Oral side effects:
- candidiasis
- altered taste
- dry mouth
