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Y4 - CCC & PC > Asthma > Flashcards

Asthma Flashcards

1
Q

What is the defintion of asthma?

A

a chronic respiratory condition characterised by hyper-responsive airways which become narrow due to inflammation and tightening of the smooth muscles

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2
Q

What is the prevalence of asthma?

In which group is there a higher incidence?

A
  • 8 million people in the UK with a diagnosis
  • 5.4 million are receiving treatment
  • there is a higher incidence in children
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3
Q

What is the most common industrial lung disease?

A

occupational asthma

accounts for 15% of adult-onset asthma

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4
Q

What is the basic aetiology of asthma?

A
  • an allergen enters the airway and triggers an allergic response
  • this involves inflammation mediated by mast cells, IgE and eosinophils
  • the inflammatory cascade damages the epithelium of the airway, allowing more allergens to enter
  • this results in airway hyperresponsiveness, smooth muscle hypertrophy and mucus plugging
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5
Q

What type of airway obstruction is present in asthma?

A

reversible airway obstruction

the obstruction only happens in response to a trigger

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6
Q

What are the known associations for triggering onset of asthma?

A
  • personal or FH of atopic disease
  • social deprivation
  • tobacco smoke exposure
  • obesity
  • pollution
  • premature birth / low birth weight
  • respiratory infections in infancy
  • workplace exposures
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7
Q

What is meant by the atopic triad?

A

asthma, allergic rhinitis & eczema

there is a tendancy for these 3 conditions to occur together

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8
Q

How does someone with asthma typically present to the GP?

A

with a history of shortness of breath, dry cough and chest tightness

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9
Q

When taking an asthma history, what questions are important to ask relating to their symptoms?

A
  • “are symptoms always present?” - there must be variability in symptoms
  • “do you wake up at night breathless?” - there must be diurnal variation
  • “are there noises present when you breathe?”
  • “are there any triggers?” - could be dust, pets, smoking or exercise
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10
Q

What other areas are important to cover when taking an asthma history?

A

Establishing RFs
* FHx of asthma
* FHx or personal Hx of atopy / food allergies
* GORD can make asthma worse

Previous asthma care
* has patient ever been hospitalised, had IV steroids or intubation?

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11
Q

What are the 4 main clinical features of asthma?

What is the pattern of symptoms like?

A
  • cough
  • polyphonic wheeze
  • chest tightness
  • shortness of breath

symptoms are EPISODIC with a DIURNAL VARIATION and occur in response to TRIGGERS

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12
Q

What clinical signs might be present in an asthma patient?

A
  • expiratory polyphonic wheeze
  • nasal polyps
  • work of breathing
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13
Q

How is asthma diagnosed?

A

there is no single diagnostic test for asthma

diagnosis involves clinical judgement and supportive tests

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14
Q

What 4 tests may be performed as part of the diagnosis of asthma?

A
  • FeNO
  • spirometry
  • peak flow
  • bronchodilator reversibility testing
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15
Q

What is involved in the FeNO test?

A
  • FeNO = fractional exhaled nitric oxide
  • it measures the levels of nitric oxide when breathing out
  • NO is produced when the airways are inflamed
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16
Q

What FeNO readings would be expected in asthma?

A

FeNO is increased in asthma

  • > /= 40ppb in adults > 17
  • > / = 35 ppb in children aged 5-16
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17
Q

What 4 things are measured in spirometry?

A
  • forced vital capacity (FVC)
  • forced expiratory volume (FEV1)
  • FEV1 : FVC
  • bronchodilator reversibility
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18
Q

What is forced vital capacity (FVC)?

A

the total amount of air that can be forcibly blown out in one breath

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19
Q

What is forced expiratory volume (FEV1)?

How is this changed in asthma?

A

the volume of air that can be forcibly blown out in one second

this is REDUCED in asthma

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20
Q

What is the FEV1 / FVC?

How is this changed in asthma?

A

this is the percentage of air blown out in the first second

this should be < 0.7 in asthma

this is because FEV1 decreases with little change in FVC

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21
Q

What is bronchodilator reversibility?

What reading would be expected in asthma?

A

this determines whether lung function improves with medication

there should be a >12% and 200ml increase in FEV1 post SABA

22
Q

Typically, what would a normal spirometry graph look like?

A
  • in healthy lungs, most of the breath is blown out within the first second
23
Q

What would an obstructive pattern look like on spirometry?

A
  • this is typical of an obstructive lung condition, such as COPD and asthma
  • the air flows out of the lungs more slowly than it should (low FEV1)
  • less than 70% of the total amount is blown out in the first second
24
Q

What would a restrictive pattern look like on spirometry?

A
  • the total amount of air that you can breathe in is reduced
  • the speed that you can breathe out is preserved
  • both the FEV1 and FVC will be lower than predicted, but the ratio between the 2 will not be reduced
25
Q

How is bronchodilator reversibility testing performed?

A
  • 400 micrograms of salbutamol is administered and spirometry is repeated after 15 mins
26
Q

What do the results of bronchodilator reversibility show?

A
  • reversibility is present if spirometry improves
  • the presence of reversibility suggests a diagnosis of asthma
  • the absence of reversibility suggests a fixed respiratory pathology (e.g. COPD)
  • partial reversibility suggests a mixed picture
27
Q

How is peak flow measured?

A

it measures how fast a patient can breathe out after a full breath in

the score is always lower if the airways are inflamed

28
Q

When is peak flow used in clinical practice?

A
  • can be used to diagnose asthma, monitor the response to treatment or monitor recovery after an attack
  • in diagnosis, a patient is asked to keep a peak flow diary
  • this should show > 20% variability over 2-4 weeks
29
Q

What are the main aims of asthma management?

A
30
Q

Before pharmacological treatment, what are the fundamentals of managing asthma?

A
  • ensure correct diagnosis
  • avoid triggers
  • smoking cessation
  • adherence to all medications and ensuring correct technique is used
31
Q

What are the 2 different groups of medication someone with newly diagnosed asthma is given?

A

Preventer medication:
* these are inhaled corticosteroids that reduce airway inflammation

Reliever medication:
* these cause smooth muscle relaxation to open the airways to relieve the symptoms

32
Q

What is the main preventer medication used?

A

low dose inhaled corticosteroids

(e.g. beclomethasone)

these are taken daily to prevent asthma symptoms and attacks

thiis is the most effective treatment when taken correctly

33
Q

What is the main reliever medication used?

How long does this last for?

A

short-acting beta-2 agonists

(e.g. salbutamol)

this has a rapid onset of action and lasts for 4 hours

this is only for symptom relief and is not effective in exacerbations

increased use can predict exacerbations

34
Q

What additional medications may be added on to asthma treatment?

A

other more intense reliever medications to reduce symptoms and open the airways

  • leukotriene receptor antagonists (LRTA)
  • long-acting beta-2 agonists (LABA)
  • long acting muscarinic antagonist (LAMA)
35
Q

What is an example of a LABA?

How do these work and when should they be used?

A

salmeterol

  • they act on beta-2 receptors to cause smooth muscle relaxation
  • they have a 12 hour duration of action
  • should only be used alongside regular ICS
36
Q

How is it decided at what level to initiate medical treatment?

How is control maintained and response to treatment measured?

A
  • treatment initiated at a level appropriate to the severity of the patient’s asthma
  • control maintained by increasing treatment as necessary
  • the response to treatment should be reviewed 4 to 8 weeks after any medication change
37
Q

What is meant by MART?

A

maintenance and reliever therapy

combination inhaler with a steroid and fast-acting LABA

38
Q

What is involved in the stepwise management of asthma in adults?

A
39
Q

How often should treatment be reviewed?

What should be done if the treatment is not working?

A

every 4 to 8 weeks

  • if treatment does not work, assess adherence and whether it is being taken correctly
  • if satisfied, then stop this treatment
40
Q

How often should patients with asthma be reviewed?

Which groups may be reviewed more regularly?

A
  • patients with asthma should be reviewed at least annually
  • some groups are reviewed more often:
    poor lung function
    severe asthma
    history of asthma attack in last year
    increased risk of poor outcomes
41
Q

What are the important areas to cover in an asthma review?

A
42
Q

What are the expected outcomes from an asthma review?

A
  • adjustment of treatment
  • review asthma management plan
  • education and support
43
Q

What is particularly important to assess during an asthma review?

A

inhaler technique

  • patient may also have spacers to improve lung deposition of the drug

ask patient to demonstrate how they use their inhaler

44
Q

What is meant by an acute exacerbation of asthma?

How can it be categorised?

A

the onset of severe asthma symptoms

  • severity can be characterised as moderate, severe or life-threatening
45
Q

What is meant by a moderate asthma attack?

A

PEFR will be 50-75% of best/predicted

46
Q

What is meant by a severe asthma attack?

How might someone present?

A
  • PEFR is 33-50% of best/predicted
  • RR >/= 25 per min
  • pulse rate >/= 110 bbpm
  • often unable to complete sentences and use of accessory muscles
47
Q

What is meant by a life-threatening asthma attack?

How might someone present?

A
  • PEFR is < 33% of best/predicted
  • O2 sats < 92%
  • patient is exhausted and may be confused
  • there is poor respiratory effort with cyanosis or silent chest
  • there may be cardiac arrhythmia or haemodynamic instability
48
Q

When is hospital admission required for an acute exacerbation?

A
  • hospital admission is needed for severe or life-threatening asthma that does not adequately respond to initial treatment
49
Q

What is the management for acute exacerbations of asthma?

A
  • increased doses of ICS
  • SABA
  • short course of oral prednisolone
50
Q

When should a patient be followed up following an acute exacerbation of asthma?

A
  • if admitted to hospital, they should be followed up within 2 days of discharge
  • if not admitted, they should be followed up within 48 hours of presentation

Y4 - CCC & PC (34 decks)

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