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MC > Asthma > Flashcards

Asthma Flashcards

1
Q

Asthma is defined by the presence of both of the
following:
1
2

A
  • excessive variation in lung function

* respiratory symptoms (

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2
Q

What is meant by excessive variation in lung function

A

(‘variable airflow limitation’ i.e. variation in expiratory
airflow that is greater than that seen in healthy
people)

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3
Q

In young children in whom lung function testing
is not feasible, including most preschool children,
asthma is defined by the___________

A

presence of variable respiratory symptoms.

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4
Q

BA

It has an unacceptable mortality rate of
approximately________of the population.

A

5 per 100 000

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5
Q

BA

It tends to develop between the ages of _______ but can develop at any age

A

2 and 7 years,

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6
Q

Key test for BA

A

Spirometry is the key investigation

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7
Q

New aerosols, notably _________
have non-CFC propellants leading to increased
lung deposition and thus requiring overall lower
dosage.

A

hydrofluoroalkanes,

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8
Q

Pathophysio of BA

  • infiltration of the mucosa with_______
  • _________
  • intermittent airway narrowing (due_______
A 
inflammatory cells (especially eosinophils) and cellular
elements

airway hyper-responsiveness

to bronchoconstriction, congestion or oedema of
bronchial mucosa or a combination of these)

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9
Q

About 90% of children with atopic symptoms
and asthma demonstrate ________
responses to dust mite extract

A

positive skin-prick

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10
Q

Classic Sx of BA

A
  • wheezing
  • coughing (especially at night)
  • tightness in the chest
  • breathlessness
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11
Q

Auscultation findings of BA

A

diffuse, high-pitched wheezes throughout inspiration and most of expiration, which is usually prolonged

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12
Q

If wheeze
is not present during normal tidal breathing it may
become apparent during a ______

A

forced expiration

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13
Q

Spirometry: a value of________ for FEV 1 /VC ratio
indicates obstruction. It is the more accurate test
and recommended for those who can perform it
(i.e. most adults and children >6 years).

A

<75%

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14
Q

Measurement of peak expiratory flow rate
(PEFR) or spirometry before and after SA β A: has
a characteristic_________

A

improvement >15% in FEV 1 and

PEFR.

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15
Q

__________ airway reactivity is
tested in a respiratory laboratory to inhaled
histamine, methacholine or hypertonic saline.
Sometimes useful to confirm diagnosis

A

Inhalation challenge tests:

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16
Q

Other tests for BA

A

Mannitol inhalation test.

An exercise challenge may also be helpful.

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17
Q

Significant advances in the management of asthma

The realisation that asthma is an inflammatory
disease. Therefore the appropriate first- or secondline
treatment in moderate to severe asthma
is ____ or _________

A

inhaled sodium cromoglycate (especially in

children) or inhaled corticosteroids (ICS).

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18
Q

Significant advances in the management of asthma

2 The regular use of _________
3 The use of spacers attached to_______
4 Improved and more efficient inhalers.
5 Combined________

A

spirometry.

inhalers/puffers.

long-acting relievers and preventers including combinations of long-acting β -agonists
(LA β A) and ICS—the fixed-dose inhalers.

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19
Q

Patients with moderate to severe chronic asthma
require regular measurement of ______ which is more
useful than subjective symptoms in assessing asthma
control

A

PEFR,

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20
Q

Goal of measuring PEFR

A

This allows the establishment of a baseline
of the ‘patient’s best’, monitors changes, and allows
the assessment of asthma severity and response to
treatment

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21
Q

______ are not a substitute for spirometry

A

Peak flow meters

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22
Q

Some people who have trouble using metered dose
inhalers (MDIs) can have a special________fitted onto
the mouthpiece of the inhaler

A

‘spacer’

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23
Q

Children under 5–6 years and/or 20 kg can use an

MDI and a ______

A

small volume valved spacer (AeroChamber,

Breath-A-Tech) with a face mask.

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24
Q

Goals of BA Tx

• absent or minimal _________
• maintain best possible lung function at all
times—keep asthma under control

A

daytime symptoms and no nocturnal symptoms; restore normal airway function (>80% of predicted)

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25
Q

Definition of good BA control

A

• Minimal symptoms day and night
• No nocturnal waking due to asthma
• No limitation of normal or physical activity
• Minimal need for reliever medication
• No exacerbation
• Normal lung function (FEV 1 and/or PEFR >80%
predicted or best)
• No side effects of medication
• Near or near-normal lung function (i.e. >80%
predicted)

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26
Q

These medications are directed towards the
underlying abnormalities—bronchial hyperreactivity
and associated airway inflammation

A

‘Preventer’ drugs or anti-inflammatory

agents

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27
Q

Treatment with a ‘preventer’ is recommended if asthma

episodes are ______ or those who use SA β A____

A

> 3/week

>3 times a week

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28
Q

ICS types

A
  • beclomethasone
  • budesonide
  • ciclesonide (single daily dose)
  • fluticasone
29
Q

Dose range of ICS

A

• 400–1600 mcg (adults); aim to keep below 500

mcg children and 1000 mcg (adults)

30
Q

SE of ICS

• oropharyngeal candidiasis, dysphonia (hoarse
voice)—less risk with once daily\_\_\_\_\_\_\_
• bronchial irritation: cough
• \_\_\_\_\_\_\_\_\_ (doses of 2000 mcg/daily;
sometimes as low as 800 mcg)
A

ciclesonide

adrenal suppression

31
Q

Intermittent BA

Status before treatment

Lung function FEV1 or PEFR (% predicted)

A

Episodic Symptoms

32
Q

Intermittent BA

Recommended β-agonist

Estimated starting daily dose range of ICS
required to achieve good control

A

SAβA prn

Regular ICS not required Add preventer if ≥3 SAβA/week

33
Q

Mild persistent

Status before treatment

Lung function FEV1 or PEFR (% predicted

A

Symptoms >weekly, not every day Night symptoms >2 per month Symptoms regularly with exercise

≥ 80%

34
Q

Mild persistent

Recommended β-agonist

Estimated starting daily dose range of ICS
required to achieve good control

A

SAβA prn

<250 mcg beclomethasone
<400 mcg budesonide
<250 mcg fluticasone
<160 mcg ciclesonide
Increase dose if >2 SAβA
2–3 times daily
35
Q

Moderate persistent

Status before treatment

Lung function FEV1 or PEFR (% predicted

A

Symptoms every day Night symptoms >weekly
Several known triggers apart from exercise

60–80 %

36
Q

MOd persistent

Recommended β-agonist

Estimated starting daily dose range of ICS
required to achieve good control

A

LAβA + SAβA prn

250–400 mcg
beclomethasone
400–800 mcg
budesonide
250–500 mcg
fluticasone
160–320 mcg
ciclesonide
37
Q

Severe persistent

Status before treatment

Lung function FEV1 or PEFR (% predicted

A

Symptoms every day Wakes frequently at night with cough/ wheeze, Chest tightness on waking, Limitation of physical activity

<60%

38
Q

Severe persistent

Recommended β-agonist

Estimated starting daily dose range of ICS
required to achieve good control

A

LAβA + SAβA prn

>400 mcg
beclomethasone
>800 mcg
budesonide
>500 mcg
fluticasone
>320 mcg
ciclesonide
39
Q

ICSs have a________ curve so it may not
be necessary to prescribe above ICS doses considered
high

A

flat dose–response

40
Q

________ is used mainly for exacerbations. It
is given with the usual inhaled corticosteroids and
bronchodilators

A

Prednisolone

41
Q

Dose of Prednisolone

A

• up to 1 mg/kg/day for 1–2 weeks

42
Q

These are sodium cromoglycate (SCG) and nedocromil

sodium

A

Cromolyns

43
Q

AE for Cromolyns

A

local irritation may be caused by the dry powder. Systemic

effects do not occur.

44
Q

_______is used for frequent episodic asthma
in children over 2 years of age for the prevention of
exercise-induced asthma and the treatment of mildto-
moderate asthma in some adults

A

Nedocromil

45
Q

These drugs, which include montelukast and
zafirlukast, are very useful for seasonal asthma and
aspirin-sensitive asthma and reduce the need for
inhaled steroids or

A

Leucotriene antagonists

46
Q

Montelukast is taken as a _________

A

5 or 10 mg chewable tablet once daily

47
Q

Indications for preventive therapy

Guidelines for introducing preventive asthma therapy
in adults and children include any of the following:

  • requirement of β 2 -agonist _______
  • symptoms (non-exercise______
  • spirometry showing ______
A

> 3–4 times each week or >1 canister every 3 months (excluding preexercise)

> 3–4 times per week between attacks

reversible airflow obstruction during asymptomatic phases

48
Q

Indications for preventive therapy

Guidelines for introducing preventive asthma therapy
in adults and children include any of the following:

• asthma significantly interfering with physical
activity despite appropriate pre-treatment
• asthma attacks_______
• infrequent asthma attacks but ________

A

> every 6–8 weeks

severe or lifethreatening

49
Q

The three groups of bronchodilators are

1
2
3

A

• the β 2 -adrenoceptor agonists ( β 2 -agonists)—
short acting (SA β A) and long acting (LA β A)
• methylxanthines—theophylline derivatives
• anticholinergics

50
Q

These drugs ‘stimulate’ the β 2 adrenoreceptors and
thus relax bronchial smooth muscle. The inhaled
route of delivery is the preferred route

A

β 2 -agonists

51
Q

Onset of B2 agonist

A

The inhaled drugs produce measurable
bronchodilation in 1–2 minutes and peak effects
by 10–20 minutes

52
Q

The traditional agents such as _______are short-acting
preparations. The new longer acting agents (LA β A)
include____

A

salbutamol and terbutaline

salmeterol, eformoterol and vilanterol.

53
Q

These oral drugs may have complementary value
to the inhaled agents but tend to be limited by side
effects and efficacy

A

Theophylline derivatives

54
Q

This anti-IgE agent is marketed for SC injection in
patients >12 years with moderate to severe allergic
asthma treated by ICS and who have raised serum IgE
levels

A

Omalizumab

55
Q

This term is reserved for those medications that are
taken prior to known trigger factors, particularly for
exercise-induced asthma

A

Prophylactic agents

56
Q

Meds of exercise induced asthma

A

β 2 -agonist inhaler (puffer): two puffs 5 minutes
immediately before exercise last 1–2 hours. LA β A
such as salmeterol and eformoterol are more
effective

57
Q

Other drugs for exercise induced asthma

A

• SCG or nedocromil, two puffs.
• Combination β 2 -agonist + SCG (5–10 minutes
beforehand).
• Montelukast 10 mg (less in children ≥ 2 years)
(o) daily or 1–2 hours beforehand

58
Q

What are the 3 steps in BA control

A

Step 1: Assess asthma symptom control and
identify the patient’s risk factors

Step 2: Treat and adjust to achieve good control.

Step 3: Review response and monitor to maintain
control

59
Q

For breakthrough asthma or persistent poorly
controlled asthma with poor compliance switch
to _________

A 
combined medication (e.g. Seretide MDI
Accuhaler, or Symbicort).
60
Q

Techniques on how to use MDI

The open-mouth technique and the closed-mouth
technique are the main methods, and both are effective
but the _________ is preferred

A

closed-mouth technique

61
Q

The usual dose of standard MDI is _____

A

one or two
puffs (adult) every 3–4 hours for an attack (four
puffs in children

62
Q

The _______ is a breath-activated MDI which can
improve lung deposition in patients with poor inhaler
technique.

A

Autohaler

63
Q

The _______ is a dry powder delivery system that
is widely used as an alternative to the MDI. It is a
breath-activated device

A

Turbuhaler

64
Q

People who have experienced one or more of the

following are more likely to have severe attacks:

A

• previous severe asthma attack
• previous hospital admission, especially admission
to intensive care
• hospital attendance in the past 12 months
• long-term oral steroid treatment
• carelessness with taking medication
• night-time attacks, especially with severe chest
tightness
• recent emotional problems
• frequent SA β A use

65
Q

Dangerous sign (pulse) associated with BA

A

Pulsus paradoxus

66
Q

T or F

This is a good sign in BA

Chest becoming ‘silent’ with a quiet wheeze, yet
breathing still laboured

A

f

67
Q

Patients who are sensitive to________
need to be reminded that salicylates are present in
common cold cure preparations and agents such as
Alka-Seltzer

A

aspirin/salicylates

68
Q

The non-steroidal medications, ______, ________ or _________ by inhalation, are
the prophylactic drugs of choice in childhood chronic
asthma of mild-to-moderate severity.

A

montelukast (oral)

and SCG and/or nedocromil sodium

69
Q

ICS in children

Any dose equal to or greater than _______ in children can have side effects, including growth suppression and
adrenal suppression

A

400 mcg

MC (90 decks)

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