Asthma Flashcards
What is asthma?
- chronic inflammatory condition of the airways
- airways are hyper-responsive and constrict easily in response to a wide range of stimuli.
- may result in coughing, wheezing, chest tightness, and shortness of breath.
- narrowing of the airways is usually reversible (either spontaneously or with medication)
What factors increase the likelihood of asthma?
- history of atopic disorder
- family history of asthma/atopic disorder
- widespread wheeze (bilateral, predominantly expiratory)
- symptoms are worse at night and early in the morning, in response to exercise, allergen exposure and cold air and often after taking NSAIDS/beta blockers,, occur in the absence of upper respiratory infection
What test should be used to test the presence, severity and reversibility of airway obstruction?
spirometry
How is the diagnosis confirmed in people with intermediate to high probability of asthma?
with a trial of treatment
What are the three ways in which asthma affects the airways?
inflammation of the airways
increased mucous production
bronchial muscle contraction
What are the signs and symptoms of asthma?
- intermittent dyspnoea and wheeze
- nocturnal cough, often productive
- reduced air entry and inability to complete sentences
- hyperinflated chest
- hyperresonant percussion note
- tachypnoea
What investigations can be used if asthma is suspected?
peak flow sputum cultures FBC, U&Es, CRP ABG analysis spirometry - obstructive pattern skin prick test to identify allergens CXR - to exclude pneumothorax/infection
What is the first line treatment for asthma in adults?
low does inhaled corticosteroid (ICS) with background SABA
What is the second line treatment for asthma in adults?
add inhaled LABA to low dose ICS
What is the third line treatment for asthma in adults?
stop LABA and consider increasing ICS dose or if LABA helpful keep it and use increased ICS dose
consider also add on treatment such as leukotriene receptor antagonist, long acting muscarinic agent or modified-release theophylline
What rescue medication can be used at any time in adults?
prednisolone
What are the key aspects of primary care management in asthma?
annual asthma reviews - aim to step-down treatment so patients are on lowest dose possible
encourage non pharmacological treatment - e.g. smoking cessation
asthma specialist nurse to check inhaler technique
What is the first line asthma treatment in children?
very low dose inhaled corticosteroid
or
leukotriene receptor antagonist for children <5 years
What is the the second line treatment for asthma in children?
very low dose inhaled corticosteroids
PLUS
add LABA in children >5 years
add LTRA in children <5 years
What is the third line treatment in asthma in children?
no response to LABA - stop LABA and increase to low dose ICS
if benefit from LABA but control still inadequate - continue LABA and increase ICS to low dose
if benefit from LABA but control still inadequate - continue LABA and ICS and consider trial of add on therapy LTRA
