Asthma Flashcards
1) What is asthma characterised by?
2) What are the 3 factors that contribute to airway narrowing?
1) Recurrent episodes of dyspnoea, cough and wheeze caused by reversible airway obstruction
2) Mucosal swelling, inflammation and increased mucus production
What causes the swelling and inflammation in asthma?
Mast cell and basophil degranulation which results in the release of inflammatory mediators
Bronchoconstriction is caused by hypersensitivity of the airways and can be triggered - name 4 triggers
- Infection
- Allergens
- Smoking
- Night time or early morning
- Exercise
- Animals
- Cold/damp
- Dust
- Strong emotions
Name 2 symptoms of asthma
- Intermittent dyspnoea
- Wheeze
- Cough
- Sputum
1) Comment on the speech, resp rate, HR, and peak expiratory flow rate (PEFR) in patients having a:
- Moderate asthma attack
- Severe asthma attack
2) Name 4 features of a life threatening asthma attack
1) Moderate = PEFR 50-75% best or predicted, HR <110, RR <25 and normal speech
Severe = PEFR 33-50% best or predicted, HR >110, RR >25, unable to complete sentences
2) PEFR <33%, O2 sats <92%, silent chest, weak breathing, cyanosis, bradycardia, arrhythmias, hypotension, confusion, exhaustion, coma
1) What are the 2 first line investigations for asthma
2) If there’s diagnostic uncertainty after first line investigations, what 2 further tests can be done?
1) Fractional exhaled nitric oxide and spirometry with bronchodilator reversibility
2) Peak flow variability measured by keeping a diary of peak flow measurements several times per day for 2 to 4 weeks and direct bronchial challenge test with histamine or methacholine
Acute asthma management (1)
1) What are the 3 medications given immediately in the case of an acute asthma attack?
2) What are the 2 other drugs that may be considered in life threatening acute asthma?
1) Nebulised salbutamol (beta2 agonist), nebulised ipratropium bromide and a steroid (oral prednisolone or IV hydrocortisone)
2) Magnesium sulphate and aminophylline infusion
Chronic asthma management (1)
1) What is the 1st step of asthma management?
2) What is the 2nd step of asthma management?
3) What is the 3rd step of asthma management?
4) What is the 4th step of asthma management?
5) What is the 5th step of asthma management?
1) SABA inhaler as required for infrequent wheezy episodes
2) Add a regular low dose steroid inhaler
3) Add a LABA inhaler - only continue if patient has good response
4) Consider trial of oral leukotriene receptor antagonist, oral SABA, oral theophylline or oral LAMA. Still in conjunction with previous therapy
5) Add regular oral prednisolone + titrate inhaled corticosteroids to a high dose
Does peripheral tingling during episodes of dyspnoea make a diagnosis of asthma more or less likely?
Less
For the diagnosis of asthma:
1) An exhaled FeNO of how many parts per billion or greater?
2) A post-bronchodilator improvement in lung volume of how many ml or more?
3) A post-bronchodilator improvement in FEV1 of what percentage or more?
4) A peak expiratory flow rate variability of what percentage or more?
5) An FEV1/FVC ratio of what?
1) 40 billion
2) 200 ml
3) 12%
4) 20%
5) <70%
How is a diagnosis of asthma made in children <5?
Clinical judgement
How does diagnosing asthma vary from children 5-16 y.o. and adults?
5-16 y.o. = bronchodilator + reversibility. FeNO should only be requested if normal/obstructive spirometry and a negative bronchodilator reversibility
Adults:
- Ask about improvement of symptoms on days away from work or holidays
- Bronchodilator + reversibility
- FeNO
What is the minimum amount of time you should wait between a 1st and a 2nd puff of an inhaler for asthma?
30s
