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Respiratory (LECTURE NOTES) > Asthma > Flashcards

Asthma Flashcards

1
Q

Define asthma

A

A disease characterised by airway inflammation with increased airway responsiveness resulting in airway obstruction

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2
Q

What are the main symptoms associated with asthma

A

Cough, wheeze, shortness of breath

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3
Q

Describe the nature of asthma

A

Dynamic and heterogeneous clinical syndrome that has a number of different patterns and which may progress through different stages

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4
Q

How much of the adult population had asthma in the UK

A

7%

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5
Q

Patients with asthma are also likely to have a high prevalence of what 3 conditions

A

Rhinitis
Urticaria
Eczema

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6
Q

What environmental change has occurred resulting in a higher prevalence of asthma

A

A more modern, urban, economically developed society

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7
Q

What 3 allergens are associated with asthma

A

House dust mites
Pet -derived allergens
Cigarette smoke

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8
Q

What 3 allergens are associated with asthma

A

House dust mites
Pet -derived allergens
Cigarette smoke

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9
Q

What type of Ig antibody is found in high levels

A

IgE

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10
Q

What are the effects of the mediators in response to an allergen

A

Contraction of the airway smooth muscle and increased vascular permeability and stimulation of airway mucus secretion

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11
Q

What do Th2 cells produce

A

Pro-inflammatory interleukins

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12
Q

What do Th1 cells produce

A

Cytokines

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13
Q

What is the function of Th2 cells in asthma

A

Enhancing IgE synthesis and eosinophil and mast cell function

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14
Q

What is the function of Th1 cells in asthma

A

to down-regulate the atopic response

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15
Q

Describe what happens to the wall of the airway in asthma

A

It is thickened by oedema, cellular infiltration, increased smooth muscle mass and glands

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16
Q

What occurs which leads to fibrosis of the airway wall

A

Airway remodelling

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17
Q

What is a prominent feature of acute severe asthma

A

Mucus plugging o the lumen of the airway

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18
Q

Define atopic asthma

A

asthma occurring in relation to inhalation of environmental antigens in a susceptible person

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19
Q

Define non-atopic asthma

A

asthma occurring without any definable relationship to an environmental antigen

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20
Q

What is the difference in airway inflammation of atopic and non-atopic asthma

A

They are identical pathologically- the inflammatory cascade of asthma can be initiated by a variety of different factors in different patients

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21
Q

What is meant by morning dipping

A

Peak expirratory flow (PEF) measurements are worse early in the morning

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22
Q

What is meant by nocturnal asthma

A

Symptoms such as cough and wheeze often distrubing sleep

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23
Q

What does eosinophilic bronchitis usually present with

A

A chronic cough

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24
Q

Describe the characteristic features on examination of patients with asthma

A

Diffuse bilateral wheeze
Prolonged expiratory phase
lower costal margin paradox

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25
Q

What are signs of a severe episode of asthma

A 
Tachycardia 
tachypnoea
cyanosis 
use of accessory muscles 
features of anxiety and general distress
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26
Q

What might chronic severe childhood asthma cause

A

chest deformity with the lower rib cage being pulled inwards

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27
Q

What might chronic severe childhood asthma cause

A

chest deformity with the lower rib cage being pulled inwards

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28
Q

What might be the reasonable next step if a careful history and clinical assessment strongly suggest the diagnosis of asthma

A

Trial of asthma treatment

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29
Q

What should be done if there is not a clear response to treatment

A

Reconsider the diagnosis

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30
Q

Confirmation of the diagnosis hinges on what?

A

demonstration of airflow obstruction that changes over short periods of time, either spontaneously (variability) or in response to treatment (reversibility)

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31
Q

What does spirometry allow that PEAK flow doesnt

A

a clearer confirmation of airflow obstruction than the PEF

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32
Q

What confirms airway obstruction

A

A reduced FEV/VC ratio (usually less than 0.7)

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33
Q

What is the standard starting does of salbutamol and when is spirometry repeated

A

200ug

15-20 minutes after

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34
Q

What is an alternative approach to test reversibility

A

A 6 weeks trial of inhaled corticosteroid (200ug of beclametasone) or a 2 week trial of an oral steroid (30mg/day prednisolone)

35
Q

An improvement in FEV1 of what volume strongly suggests asthma

A

> 400ml

36
Q

What happens to the total lung capacity in asthma

A

usually increased as a manifestation of hyperinflation and residual volume is elevated indicating air trapping

37
Q

What is airway responsiveness

A

A measure of the general “irritability” of the airways, the degree to which bronchoconstriction develops in response to physical or chemical stimuli

38
Q

In exercise testing, what is highly suggestive of asthma

A

Post exercise fall in FEV1 or spirometry before and after 5-10 minutes of exercise

39
Q

How can the degree of airway responsiveness be measured precisely in the lab

A

Methacholine provocation tests

40
Q

What is involved in the methacholine provocation test?

A

the patient will inhale increasing doses of nebulised methacholine or histamine, starting at a very low dose and serial spirometry is performed

41
Q

What is involved in the methacholine provocation test?

A

the patient will inhale increasing doses of nebulised methacholine or histamine, starting at a very low dose and serial spirometry is performed

42
Q

What is the most common test for hypersensitivity

A

Skin prick test to identify atopy and to detect particular sensitivity to a specific antigen with a view to exclusion of exposure where possible

43
Q

What is a positive result to a skin test

A

A weal with a surrounding erythematous flare at about 15 minutes

44
Q

What is a means of measuring the level of circulating IgE specifically directed towards a particular antigen

A

Radioallergosorbent testing (RAST)

45
Q

What are 3 really good questions to ask during an asthma review consultation

A

In the last month/ week have you had difficulty sleeping due to your asthma?
Have you had your usual asthma symptoms during the day?
Has your asthma interfered with your usual daily activities

46
Q

What are 3 really good questions to ask during an asthma review consultation

A

In the last month/ week have you had difficulty sleeping due to your asthma?
Have you had your usual asthma symptoms during the day?
Has your asthma interfered with your usual daily activities

47
Q

What two drugs should be avoided in asthamtics

A

B Blockers and aspirin

48
Q

What is used to relieve symptoms of bronchoconstriction

A

SABAs

49
Q

What is used to treat the underlying chronic inflammatory process in asthma

A

Inhaled corticosteroids

50
Q

What is sometimes used with a corticosteroid

A

LABA

51
Q

How do SABAs work?

A

They stimulate B adrenoceptors in the smooth muscle of the airway producing smooth muscle relaxation and bronchidilation

52
Q

How long does it take SABAs to work and how long do they work for

A

15 minutes

4-6 hours

53
Q

What are the side effects of SABAs

A

Tremor

Palpitations

54
Q

If a patient needs their reliever more than 3 times in a week what should the clinician do?

A

Increase the patients maintenance therapy

55
Q

When do LABAs work

A

After 12 hours

56
Q

When is LABA use recommended

A

with the use of inhaled corticosteroids

57
Q

As a result, what is often used now in asthma management

A

Combination inhalers

58
Q

What can be used as both a reliever and a maintenance therapy

A

Symbicort

59
Q

How do anti-muscarinic bronchodilators work

A

They produce bronchodilation by blocking the bronchoconstrictor effect of the vagal nerve stimulation on bronchial smooth muscle

60
Q

How do Theophyllines work

A

They inhibit the metabolism of cAMP by the enzyme phosphodiesterase

61
Q

What are some side effects of theophyllines

A 
Nausea
vomiting
headache 
tachycardia 
malaise
62
Q

What are some side effects of theophyllines

A 
Nausea
vomiting
headache 
tachycardia 
malaise
63
Q

How does magnesium work in asthma

A

Acts as a smooth muscle relaxant

64
Q

What is considered a low dose of inhaled steroids

A

below the equivalent of 800ug/day

65
Q

What are some side effects of inhaled steroids

A

Oropharyngeal candidiasis or hoarseness of the voice

66
Q

What can reduce the hoarseness

A

Using a spacer device and taking a drink of water after use

67
Q

What is sodium cromoglycate

A

A preventative inhaled treatment that has a number of anti-inflammatory actions including stabilisation of mast cells

68
Q

Is sodium cromoglycate more or less effective than inhaled steroids

A

Less

69
Q

Is sodium cromoglycate more or less effective than inhaled steroids

A

Less

70
Q

WHen would oral steroid treatment be needed

A

To control exacerbations of asthma

71
Q

How long is a typical oral steroid treatment

A

about 7 days

72
Q

How do leukotriene receptor antagonists work

A

They block the effects of cysteinyl leukotrienes - which are metabolites of arachidonic acid with bronchoconstrictor and pro-inflammatory actions

73
Q

What is Anti-IgE treatment

A

a monoclonal antibody that binds to IgE

74
Q

What is control of asthma defined as

A 
No daytime symptoms 
No night -time wakening due to asthma 
no need for reliever medication 
no exacerbations 
no limitations on activity including exercise 
normal lung function >80% predicted 
minimal or no side effects of treatment
75
Q

Why is the inhaled route for bronchodilator and corticosteroid drugs preferred

A

The drugs can be delivered directly to the airways reducing the risk of systemic adverse effects

76
Q

Why is the inhaled route for bronchodilator and corticosteroid drugs preferred

A

The drugs can be delivered directly to the airways reducing the risk of systemic adverse effects

77
Q

How are metered dose inhalers drugs metabolised

A

by first pass metabolism in the liver

78
Q

What can be used to overcome metered dose inhalers

A

Large volume spacer devices

79
Q

What does a large volume spacer result in

A

Reduced need for coordination of inspiration and actuation of the inhaler
Improves delivery of the drug to the lower airways

80
Q

How often should spacer devices be replaced

A

Yearly

81
Q

What are the 4 signs of an acute severe asthmatic attack

A

PEF 33-50% of best or predicted
RR 25 or more
HR is 110 or more
Inability to complete sentences in one breath

82
Q

What are some clinical signs of life threatening asthma

A 
Altered conscious level 
exhaustion
arrhythmia 
hypotension
cyanosis
silent chest 
poor respiratory effort
83
Q

What are some investigations that should be done for a severe asthmatic attack

A

ABGs
U&E
ECG
CXR

Respiratory (LECTURE NOTES) (19 decks)

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