Week 2 - Asthma In Adults Flashcards
When are symptoms usually worse?
Beginning or end of day
What are 5 symptoms?
Chest tightness, cough, wheeze, SoB and difficulty in expiration
What are the proven aetiological factors? (3)
- Hereditary (atopy)
- Maternal/grandmother smoking
- Occupational (bakers, planters, shellfish workers)
What is Atopy? What influences it most?
Body’s predisposition to develop antibody IgE, and its hereditary. Linked to asthma, eczema and hay fever.
Maternal atopy is most influential
What are the non-proven trends in aetiology of asthma?
Obesity, diet and ‘hygiene hypothesis’ as a child
What history would you look out for in the initial clinical assessment? (6)
Symptoms, variation (how often and when), triggers, past medical history, family and social history, current asthma drugs
What do finger clubbing or cervical lymphadenopathy suggest?
Not asthma but lung cancer
What is stridor and what does it suggest?
Harsh wheeze on inspiration - foreign body/tumour obstructing airways
What does an asymmetrical expansion or dull percussion chest sound suggest?
Pneumonia or collapsed lung
What are 3 other causes of a general airflow obstruction?
COPD, cystic fibrosis or bronchiectasis
What test should be done in suspicion of asthma?
Spirometry FEV1/FVC test
If the FEV1/FVC ratio is below 70%, what further tests should follow?
- Full pulmonary function test to exclude COPD and emphysema
- CO gas transfer test
- Oral steroids for 2 weeks and see peak flow difference
What does a CO gas transfer test tell us?
Measures affinity of CO to haemoglobin. In asthma this should be normal or increased. In COPD it should be decreased due to alveolar reduction. Can be used to differentiate between the 2
How is the FEV1/FVC test carried out to test for asthma?
Check result before and 15 minutes after salbutamol administration. If spirometry increases, most likely astma
If spirometry is normal, what further tests do we carry out for asthma?
- Check for >20% variability in peak flow, 3X a day for 2 weeks
- Patient inhales various chemicals, and test if airway reactivity increases causing FEV1 to drop
- high Exhaled NO levels - airway inflammation
What does moderate asthma look like?
Can speak, HR below 110, Resp. Rate below 25, peak flow 50-75%, O2 saturation 92% and above, PaO2 8kPa or above, low PaCO2 (exhaling a lot)
What do we look for to determine grade of asthma? (7)
Speech, HR, RR, O2 saturation, peak flow, PaO2, PaCO2
What are the 4 grades of asthma?
Moderate, severe, life threatening or near fatal
What does severe asthma look like?
Anything opposite to moderate asthma
HR >120, RR >30, and peak flow 33%-50% low
What does life threatening asthma look like?
Grunting, impaired consciousness, exhaustion or confusion. Peak flow below 30%. Cyanosis, silent chest, paCO2 is normal - not exhaling well
What does near fatal asthma look like?
PaCO2 is high, needs manual ventilation
What inhaled therapies are available for asthma?
Preventation - MDI (metre dose inhalers) and DPI (dry powder inhalers)
Relieving flares - SABA - salbutamol by MDI or DPI
What oral therapies are available for asthma? (3)
LTRA - leukotrine receptor antagonist
Theophylline (bronchodilators) - difficult asthma
Prednisolone - long term, not ideal
What specialist option therapies are available for some asthma patients?
Omalizumab (anti IgE) and Mepolizumab (anti IL-5) target pathological process of asthma development. May help patients come off oral steroids
When would IV be used for asthma treatment? What’s a negative?
In hospital for faster delivery, hydrocortisone should be used to decrease inflammation
Hydrocortisone IV is shorter acting so need it 3X a day, rather than once a day for prednisolone
What is level 1, 2 and 3 care?
1 is clinic based
2 is single organ support
3 is high intensity care
