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y4 acute care > Asthma > Flashcards

Asthma Flashcards

1
Q

What are the signs of a severe asthma attack? (4 things)

A
  1. Inability to complete sentences
  2. Pulse over 110bpm
  3. Resp rate over 25 / min
  4. Peak Expiratory Flow (PEF) 33-50%
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2
Q

What are the signs of a life threatening asthma attack? (6 things)

A
  1. PEF below 33%
  2. Normal PCO2
  3. Bradycardia
  4. Silent chest
  5. Cyanosis
  6. Confused / exhausted
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3
Q

What is Asthma? (3 things)

A
  1. Chronic inflamm condition of airways
  2. Secondary to Type 1 Hypersensitivity
  3. Causes episodic bronchoconstriction
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4
Q

What are the triggers for Asthma? (9 things)

A
  1. Cold / damp air
  2. Allergens: Dust / Animals / Pollen
  3. NSAIDs
  4. Beta blockers
  5. Exercise
  6. Night / early morning
  7. Infections
  8. Smoking
  9. Strong emotions

CAN BE NISS

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5
Q

When is asthma worse?

A

@ sleep

(diurnal variation)

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6
Q

What factors contribute to the reversible airway obstruction in asthma? (3 things)

A
  1. Bronchial muscle contraction
  2. Mucosal swelling / inflamm
  3. Increased mucus production
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7
Q

What is the mucosal swelling / inflamm in asthma caused by?

A

Mast cell and basophil degranulation –> release of inflamm mediators

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8
Q

What is asthma characterised by? (3 things)

A
  1. Breathless
  2. Tight chest
  3. Wheezy cough
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9
Q

What are the Signs of asthma? (4 things)

A
  1. Tachypnoea
  2. Audible polyphonic wheeze
  3. Hyperinflated chest
  4. Hyper-resonant percussion note
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10
Q

What is the wheeze in asthma caused by?

A

Reversible airway obstruction

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11
Q

What extra things should you ask for in Asthma pt? (4 things)

A
  1. Disturbed sleep? (quantify bc can be sign of severe Asthma)
  2. Exercise tolerance? (quantify)
  3. Acid reflux (40-60%)
  4. Other diseases: Eczema, hay fever, allergy?
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12
Q

What investigations should you do for sus Asthma? (NICE) (4 things)

A

First Line:

  1. Fractional Exhaled Nitric Oxide (FENO)
  2. Spirometry

If diagnosis still unclear:

  1. Peak Flow (keep diary few times per day for 2-4 wks)
  2. Direct Bronchial Challenge Test w histamine or methacholine
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13
Q

What is the Fractional Exhaled Nitric Oxide test for Asthma? (2 things)

A
  1. Measures how much Nitric Oxide is in breath
  2. 40+ ppb of NO = airways inflammed –> probs asthma
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14
Q

What investigations should you do for an ACUTE Asthma ATTACK? (6 things)

A
  1. Peak Flow
  2. Sputum Culture
  3. Blood Culture
  4. FBC
  5. CRP
  6. ABG
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15
Q

What may a FBC show in an ACUTE Asthma ATTACK?

What does this suggest?

A

High Eosinophils (type of WBC)

Suggests atopic asthma (ashma triggered by allergens)

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16
Q

What does an ABG show in ACUTE Asthma Attacks? (3 things)

What does this mean?

A
  1. Normal / Slightly low PaO2
  2. Low PaCO2
  3. High pH

Hyperventilation

17
Q

What does an ABG show in Resp Failure? (3 things)

A
  1. Low PaO2
  2. High PaCO2
  3. Low pH (resp acidosis)
18
Q

What inevestigations should you do for CHRONIC Asthma? (5 things)

A
  1. Peak Flow
  2. Spirometry (low FEV1/FVC ratio)
  3. CXR
  4. Skin prick test (to identify allergens)
  5. Direct Bronchial Challenge test w histamine or methacholine
19
Q

What will Spirometry tests show in Asthma?

A

Low FEV1/FVC ratio = obstructive disease

20
Q

What will a CXR show in Asthma?

A

Hyperinflation

(flattened diaphragm = hyperinflation)

21
Q

What are some differentials that present similarly to Asthma? (8 things)

A
  1. Pulmonary oedema
  2. COPD (can co-exist)
  3. Large airway obst (foreign body / tumour)
  4. Superior Vena Cava obst (wheeze / dyspnoea but NOT episodic)
  5. Pneumothorax
  6. PE
  7. Bronchiectasis
  8. Obliterative bronchiolitis (sus in elderly)
22
Q

How are the CF of COPD similar to Asthma? (3 things)

A
  1. Dyspnoea
  2. Cough
  3. Wheezing
23
Q

How are the CF of COPD DIFFERENT to Asthma? (6 things)

A
  1. COPD = Progressively worsening airway obst // Asthma = Episodic airway obst
  2. COPD NOT improved by bronchodilators / steroids (Asthma is)
  3. COPD inflamm = MAC + Neut // Asthma = Eusinophils + Mast Cells + T Cells
  4. COPD = NO airway remodelling (Asthma has)
  5. COPD = Frequent emphysema (none in Asthma)
  6. COPD = More common in 50+ yrs
24
Q

How are the CF of Large Airway Obst (foreign body) similar to Asthma? (2 things)

A
  1. Wheeze (in foreign body)
  2. CXR hyperinflation (in foreign body)
25
Q

How are the CF of Large Airway Obst (tumour) different to Asthma? (2 things)

A
  1. Stridor instead of Wheeze (in tumour)
  2. Flow-Volume Loop shows flow limited in BOTH insp + exp curves (see Fiixed obst in pic)
26
Q

How is a diagnosis of a Large Airway Obst (foreign body / tumour) confirmed?

A

Bronchoscopy (can use it to remove foreign body as well)

27
Q

What is the Step-wise management guidelines for Asthma? (7 steps)

A

Step 1: Short Acting B2 Agonist (SABA) (Salbutamol) (PRN)

Step 2: Low Dose Inhaled Corticosteroid (ICS) (Fluticasone)

Step 3: Maintence And Reliever Therapy (MART) (ICS + LABA)

Step 4: Medium Dose ICS / Oral Leukotriene Receptor Antagonist (LTRA) (Montelukast / Zafirlukast)

Step 5: High Dose ICS / Oral Theophylline / Long Acting Muscarinic Receptor Antagonist (LAMA) (Tiotropium)

(When you go up a step, ADD what’s written, not replace)

28
Q

What is Maintence And Reliever Therapy (MART)?

A

ICS + LABA in a single inhaler

(LABA has to be fast acting, e.g Formoterol)

29
Q

What is the use of Beta Agonists in Asthma?

A

Relax bronchial smooth muscle

(by increasing cAMP levels)

30
Q

What are the Side Fx of Salbutamol (SABA)? (4 things)

A
  1. Tachyarrhythmias
  2. Tremor
  3. Anxiety
  4. Hypokalaemia

TTAH

31
Q

Why are Corticosteroids better to be inhaled?

A

To minimize Systemic fx

32
Q

What is the use of Corticosteroids in Asthma?

A

Reduce bronchial mucosal inflamm

33
Q

What should you advise patients to do after taking ICS (Inhaled Corticosteroids)?

A

Rinse mouth to prevent Oral Candidiasis (thrush)

34
Q

What is the use of Theophylline in Asthma?

A

Reduces bronchoconstriction

(by inhibiting phosphodiesterase –> increases cAMP levels)

35
Q

What is the use of LAMA (Tiotropium) in Asthma?

A

Reduce muscle spasm together w Beta Agonists

36
Q

What is the use of Leukotriene Receptor Antagonists (LTRA)(Montelukast / Zafirlukast) in Asthma?

A

Block fx of Cysteinyl leukotrienes on airways

(i.e dey cause dilation of airway)

y4 acute care (31 decks)

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