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Med Year 3 > Asthma > Flashcards

Asthma Flashcards

1
Q

what is asthma

A

diffuse airway inflammation due to a variety of stimuli resulting in reversible partial or complete bronchoconstriction

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2
Q

summarise the pathophysiology of airway inflammation

A

bronchoconstriction
airway inflammation and oedema
hyper-reactivity due to narrowing of airways
airway remodelling (desquamation, angiogenesis etc)

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3
Q

what causes asthma?

A 
exercise
allergies
pollen
dust
smoke
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4
Q

what are the symptoms of asthma

A

dyspnea, chest tightness, audible wheeze and cough

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5
Q

what are the signs of asthma

A

wheeze, tachypnea, tachycardia, pulsus paradoxus, hyper-inflation of chest, hyper-resonant percussion note, visible effort to breath, expiration phase prolonged

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6
Q

what are the signs of a severe asthma attack

A

resp rate >25
pulse >110
inability to complete sentences
PEF 30-50% of normal

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7
Q

what are the signs of a life threatening asthma attack

A 
cyanosis
exhaustion
altered conscious level
silent chest 
arrythmias 
type 1 resp failure
O2 <92
PEF <33%
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8
Q

what questions do you ask in annual reviews for asthma

A

have you had trouble sleeping due to your symptoms

do you have your usual asthma symptoms in the day

has it interfered with your daily activities

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9
Q

what are normal breath sounds called

A

vesicular, longer inspiration than exp

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10
Q

what are bronchial breath sounds and when are they heard

A

abnormality in lung that is far from airways

heard in consolidation, lobar collapse with patent bronchus and lung cavity

gap between both phases, equal

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11
Q

how can you check for further consolidation

A

tactile fremitus
say 99 = shouldn’t be loud
say e
whispering

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12
Q

what types of wheeze are commonly heard

A

expiratory
polyphonic - heard if bronchioles are spasming

monophonic - small wheezing starting at different times - heard if pathology in local area

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13
Q

when are crackles or crepitations heard

A

on inspiration, in pneumonia, COPD, pulmonary fibrosis or oedema, lung abscesses

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14
Q

what are the two types of crackles

A

coarse v fine

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15
Q

what is a pleural friction rub and when is it heard

A

sounds like walking on snow, when two pleura rub against each other due to pleurisy

also in consolidation, pulmonary infarction

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16
Q

stridor

A

loud, high pitched crowing sound during inspiration

caused by UPPER airway narrowing - don’t need a stethescope

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17
Q

what is FVC

A

amount of air person can exhale after maximally inhaling

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18
Q

what is FEV1

A

vol of air you can exhale in one second after maximally inhaling

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19
Q

what is a normal FVC/FEV1 ratio

A

70%

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20
Q

what is the ratio in obstructive lung disease

A

<70%

COPD

21
Q

what is the ratio in restrictive lung disease and give an example

A

> 70%, but FVC alone is decreased

pulmonary fibrosis

22
Q

why do you get inspiratory crackles, and with which conditions would you hear coarse v fine crackles?

A

bc if peripheral airways have collapsed, then on inspiration the airways open and the alveoli are delayed on opening and hence you hear crackles

coarse - COPD
fine - pulmonary fibrosis

23
Q

what is diffusing capacity for CO

A

partial pressure difference between inspired and expired O2, and hence extent of absorption into blood

asthma = normal or increased
COPD = decreased due to decreased effective alveoli surface area
24
Q

what are the normal values for ABGs

A

o2: 10-13 (if they are on oxygen, <11 is cause for concern)

co2: 4.5-6
pH: 7.35-7.45
HCO3: 22-26
base excess: -2 to +2

FIND TABLE FOR ACIDOSIS AND ALKALOSIS

25
Q

type 1 resp failure?

A

pao2 is low and normal paco2

26
Q

type 2 resp failure?

A

low oxygen and high CO2

27
Q

what is the normal arterial-alveolar gradient and what does an abnormality signify

A

normal = 10

problem with lung

28
Q

what is intermittent asthma

A 
main 4 symptoms less than 2x a week
less than 2x a month night time symptoms
no problems between flare-ups
PEF is 80% of normal 
less than 20% variability
29
Q

what is mild asthma

A

main symtpoms 3-6x a week
2-4 a month night symptoms
PEFR 60-80% of normal
20-30% PEF variability between days

ALSO = controlled with low-dose controller or reliever inhalers

30
Q

what is moderate asthma

A

symptoms daily
night time symptoms 5x a month
PEFR 60-80% of normal

controlled with ICS or LABA

31
Q

what is severe asthma

A

symptoms daily
frequent night time symptoms
PEFR less than 60% of normal

requires ICS or LABA to prevent it becoming uncontrolled, or if it is uncontrolled despite treatment

32
Q

what are the 4 steps to managing asthma

A
  1. mild - give them a SABA (salbutamol, 100-200mcg when required)
    2 mild persistant - give them a SABA, add inhaled corticosteroid: fluticasone or beclometasone dose depending on severity
    3 moderate persistant - LABA, SABA, and increase steroid dose if needed, if not working = add leukotriene receptor antagonist (montelukast), or theophylline and inhaled LAMA like ipratroprium
    4 - severe - inhaled steroid at highest dose and if not working then lowest dose oral prednisolone
33
Q

how do you manage an acute exacerbation of asthma once in hospital

A
  • supplemental o2 to maintain it above 92%
  • salb 5mg or terbutaline 10mg nebulished with oxygen (6-8L)
  • add ipratropium 0.5mg.6 hours if life-threatening - can combine with salb
  • IV hydrocortisone 100mg or pred 40-50mg orally
  • if not responding = Mg IV 1.2-2g
34
Q

what do you do while waiting for an ambulance

A

six puffs of salb at once or 1 puff every 5 minutes and reassess every 15

if PEFR <75%, repeat salb every 15-30min and add ipratropium

if not responding initially, add Mg

if improving = continue salb and ipratropium, if PEFR >75% give pred 40mg OD for 5-7 days

if not = ICU, mechanical ventilation

35
Q

when and how can you discharge an asthmatic patient after a serious attack

A

24 hours off nebuliser
PEFR >75% with <20% variation
give normal inhalers, and pred as above
follow up after 48 hours

36
Q

what is salbutamol and what are the side effects

A

short-acting b2 adrenoreceptor agonist causes bronchodilation

binds to b2 receptors = fine tremor and bradycardia

37
Q

why is propanolol contraindicated in asthmatic patients?

A

beta-blockers = causes bronchoconstriction

38
Q

example of a LABA and how long does it last

A

salmeterol

12 hours

39
Q

what is terbutaline

A

SABA

40
Q

what are beclomethasone and fluticasone

A

GCC - anti-inflammatory and immunomodulating

flucitasone combined with salmeterol = seretide

41
Q

what is montelukast?

A

leukotriene receptor antagonist - inhibits migration of eosinophils, neutrophils, airway oedema and bronchoconstriction

42
Q

theophylline? SE

A

inhibits phophodiesterase and prostaglandin production, causing bronchoconstriction, vasodilation

SE: adrenergic activation so tachycardia, palpitations, headaches, diarrhea etc

43
Q

how does ipratropium work

A

anti-muscarinic (muscarinic antagonists) = inhibits Ach-mediated bronchoconstriction from vagal impulses (can lead to constipation, cough, diarrhoea, dry mouth)

44
Q

what is sodium cromoglicate

A

mast cell stabiliser and prevents release of histamine, leukotrienes

45
Q

how do you analyse chest x-rays

A

read case 2 notes

46
Q

what is the FeNO test

A

fractional exhaled nitric oxide
abnormal >40
indicates inflamed airways

47
Q

brand names of inhalers

A
  • ICS: clenil, QVAR, Pulmicort, flixotide
  • LABA: serevent
  • LAMA: Spiriva
  • Combination inhaler: Seretide, Symbicort, fostair
48
Q

what investigations do you do for asthma?

A
  • spirometry
  • PEFR
  • FeNO2

Med Year 3 (25 decks)

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