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Medicine 1 Respiratory > Asthma > Flashcards

Asthma Flashcards

1
Q

What is Asthma?

A

Asthma is a chronic inflammatory condition of the airways that causes episodic exacerbations of bronchoconstriction.

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2
Q

In asthma, there is reversible airway obstruction that typically responds to ________ such as _________

A

bronchodilators, salbutamol

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3
Q

What causes bronchoconstriction in asthma?

A

Airway hypersensitivity

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4
Q

What are some typical asthma triggers?

A
  • Infection
  • Nighttime or early mornings
  • Exercise
  • Animals
  • Cold, damp, or dusty air
  • Strong emotions
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5
Q

What are some patient presentations that could suggest a diagnosis of asthma?

A
  • Episodic symptoms
  • Diurnal variability. Typically worse at night
  • Dry cough with wheeze and shortness of breath
  • History of other atopic conditions such as eczema, hayfever, and food allergies
  • Family history
  • Bilateral widespread “polyphonic” wheeze heard by a healthcare professional
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6
Q

What are some patient presentations that could suggest a diagnosis other than asthma?

A
  • Wheeze related to coughs and colds more suggestive of viral-induced wheeze
  • Isolated or productive cough
  • Normal investigations
  • No response to treatment
  • Unilateral wheeze suggesting a focal lesion or infection
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7
Q

According to the BTS/SIGN guidelines from 2016, when should you make a clinical diagnosis for asthma?

A

When there is a high clinical suspicion of asthma

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8
Q

According to the BTS/SIGN guidelines from 2016, when should you conduct testing for asthma?

A

When there is an intermediate or low clinical suspicion of asthma

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9
Q

What do the NICE 2017 guidelines suggest regarding asthma diagnosis?

A

They advise against making a diagnosis without definitive testing

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10
Q

What are the BTS/SIGN guidelines on asthma diagnosis when there is a high probability of asthma treatment?

A

Try treatment

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11
Q

What are the BTS/SIGN guidelines on asthma diagnosis when there is an intermediate probability of asthma treatment?

A

Perform spirometry with reversibility testing

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12
Q

What are the BTS/SIGN guidelines on asthma diagnosis when there is a low probability of asthma treatment?

A

Consider referral and investigating for other causes

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13
Q

List the key treatments for long-term management of asthma.

A
  • Short-acting beta 2 adrenergic receptor agonists
  • Inhaled Corticosteroids (ICS)
  • Long-acting beta 2 agonists (LABA)
  • Long-acting muscarinic antagonists (LAMA)
  • Leukotriene Receptor Antagonists (LTRA)
  • Theophylline
  • Maintenance And Reliever Therapy (MART)
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14
Q

An example of SABA includes

A

Salbutamol

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15
Q

How do Short-acting beta 2 adrenergic receptor agonists work?

A
  • They work quickly but the effect only lasts for an hour or two
  • Adrenalin acts on the smooth muscles of the airways to cause relaxation resulting in dilatation of bronchioles
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16
Q

When are Short-acting beta 2 adrenergic receptor agonists used?

A

Used as “reliever” or “rescue” medication during acute exacerbations of asthma when the airways are constricting.

17
Q

An example of ICS includes

A

Beclometasone

18
Q

What do Inhaled Corticosteroids (ICS) do?

A

Reduce inflammation and reactivity of the airways

19
Q

When are Inhaled Corticosteroids (ICS) used?

A

Used as “maintenance” or “preventer” ‘medications and are taken regularly even when well

20
Q

An example of LABA includes

A

Salmeterol

21
Q

How do Long-acting beta 2 agonists (LABA) work?

A

They work in the same way as SABA’s but have a much longer action

22
Q

An example of LAMA includes

A

Tiotropium

23
Q

How do Long-acting muscarinic antagonists (LAMA) work?

A

They block the acetylcholine receptors that are stimulated by the parasympathetic nervous system causing the bronchial smooth muscles to contract. Blocking these receptors leads to bronchodilatation.

24
Q

An example of LTRA includes

A

Montelukast

25
Q

What are leukotrienes?

A

Leukotrienes are produced by the immune system and cause inflammation, bronchoconstriction, and mucus secretion in the airways.

26
Q

How do LTRA’s work?

A

By blocking the effects of leukotrienes

27
Q

How do theophyllines work?

A

By relaxing bronchial smooth muscles and reducing inflammation

28
Q

What is the therapeutic window of theophyllines?

A

It has a narrow therapeutic window and can be toxic if used in excess, so monitoring plasma theophylline levels in the blood is required.

29
Q

How frequently should plasma theophylline levels be monitored when on theophylline treatment?

A

5 days after starting treatment and 3 days after each dose changes

30
Q

What is MART?

A

It is a combination inhaler containing a low-dose inhaled corticosteroid and a fast-acting LABA. This replaces all other inhalers and the patient uses this single inhaler regularly as a preventer and as a reliever when symptoms show.

31
Q

Both BTS/SIGN and NICE guidelines start with __________ followed by ___________

A

SABA; low dose inhaled corticosteroid

32
Q

After the first-line treatment, what medication is provided in the next step?

A

LTRA or an inhaled LABA

33
Q

List the principles of using the stepwise ladder.

A
  • Start at the most appropriate step for the severity of the symptoms
  • Review at regular intervals based on severity
  • Step up and down the ladder based on the symptoms
  • Aim to achieve no symptoms or exacerbations on the lowest dose and number of treatments
  • Always check inhaler technique and adherence at review
34
Q

List out the steps in the BTS/SIGN 2016 guidelines stepwise ladder

A
  • Add a SABA as required for infrequent wheezy episodes
  • Add a regular low dose ICS
  • Add LABA inhaler and continue ONLY if the patient has a good response
  • Consider a trial of an oral LTRA, oral beta 2 agonist (i.e. oral salbutamol), oral theophylline or an inhaled LAMA
  • Titrate the ICS up to high dose. Combine additional treatments from step 4. Refer to a specialist.
  • Add oral steroids at the lowest dose possible to achieve good control.
35
Q

List out the steps in the NICE 2017 guidelines stepwise ladder

A
  • Add a SABA as required for infrequent wheezy episodes
  • Add a regular low dose ICS
  • Add an oral LTRA
  • Add LABA inhaler and continue ONLY if the patient has a good response
  • Consider changing to a MART regime
  • Increase the inhaled corticosteroid to a ‘moderate dose’
  • Consider increasing the ICS dose to “high dose” or oral theophylline or an inhaled LAMA
  • Refer to a specialist
36
Q

Additional management for patients with asthma include

A
  • Each patient should have an individual asthma self-management programme
  • Yearly flu jab
  • Yearly asthma review
  • Advise exercise and avoid smoking

Medicine 1 Respiratory (20 decks)

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