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Yr3 - Resp Conditions > Asthma > Flashcards

Asthma Flashcards

1
Q

What is asthma?

A

Asthma is a chronic inflammatory disease characterised by reversible airway obstruction
-Initial trigger releases inflammatory mediators

Lumen is reversibly folded due to smooth muscle bronchoconstriction and mucous hypersecretion

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2
Q

What are the cardinal features of asthma?

A

Atopy/Allergen sensitization
Reversible airflow obstruction
Airway inflammation
Eosinophilia
Type 2 lymphocytes

Wheeze/+- dry cough on exertion worse with colds and allergen exposure

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3
Q

What type of immune reaction is associated with asthma?

A

Type 2 immunity in allergic asthma

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4
Q

What cytokines are released in Asthma?

A
  • IL-4 is a prominent immune mediator that supports the activation of B-cells into plasma cells to release IgE.
  • IL-5 – Responsible for the maturation and release of eosinophils in the bone marrow.
  • IL-15 is a central regulator in IgE synthesis, goblet cell hyperplasia, mucous hypersecretion, and airway hyperresponsiveness.
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5
Q

What roles does IL-5 have in asthma?

A

Maturation and releases of eosinophils in the bone marrow

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6
Q

What does role does IL-4 have in asthma?

A

A prominent lumen mediator that supports the activation of B-cells into plasma cells to release IgE

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7
Q

What effect does IgE have in asthma?

A

Mast-cell degranulation leading to the release of histamines and cytokines

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8
Q

What blood test is used to test for allergic sensitiation?

A

Blood test for specific IgE antibodies to allergens

only do once asthma diagnosis is confirmed

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9
Q

What are the risk factors for asthma?

A

Family history

Atopy (Tendency for T lymphocytes to drive production of IgE exposure

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10
Q

What environmental factors are associated with asthma?

A
  • House dust mites
  • Pollen
  • Pets
  • Cigarette smoke
  • Viral respiratory tract infections
  • Aspergillus fugimatus spores
  • Occupational allergens
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11
Q

What is the presentation of asthma?

A
  • Intermittent dyspnoea (SOB)
  • polyphonic expiratory wheeze
  • Cough (worse in the early morning and at night) + sputum. DIURNAL pattern of symptoms.
  • Nasal polyposis
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12
Q

When is the asthma cough worse during the day?

A

Worse in early morning and at night

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13
Q

What is the pattern of symptoms for asthma?

A

Diurnal

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14
Q

What are the precipitating factors for asthma?

A

• Cold air – Induced bronchospasm
• Viral infection
• Drugs (E.g., beta-blockers, NSAIDs)
• Exercise
• Emotions
• Allergens – House dust mite, pollen, fur, pets – query.
• Smoking/passive smoking
• Pollution
• Ask if symptoms remit at weekend – may be triggered at work.
N.B: Check for history of atopic disease (Allergic rhinitis, urticaria, eczema).

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15
Q

What are the examination findings for asthma?

A
  • Tachypnoea
  • Use of accessory muscles
  • Prolonged expiratory phase
  • Polyphonic expiratory wheeze
  • Reduced air entry
  • nasal polyps

in acute asthma attacks –> Hyperinflated chest and hyper-resonant percussion notes

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16
Q

What defines a moderate asthma attack for PEFR?

A

PEFR > 50-75% predicted.

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17
Q

What parameters are associated with a severe asthma attack?

A
  • PEFR 35-50% predicted
  • Pulse > 110/min
  • RR > 25/min
  • Inability to complete sentences.
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18
Q

what parameters are associated with a near fatal asthma attack?

A
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19
Q

What parameters are associated with a life-threatening asthma attack?

A
  • PEFR < 33% predicted
  • Silent chest
  • Cyanosis – PaO2 < 8 kPa, normal/high PaCO2 > 4.6 kPa, low pH <7.35.
  • Bradycardia
  • Hypotension
  • Confusion
  • Coma
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20
Q

What investigations are performed for the diagnosis of asthma?

A

Spirometry:
FEV1/FVC ratio <70% indicates airway obstruction
Bronchodilator reversibility (BDR) test is an imrpovement in FEV1 of 12% or more

Fractional exhaled nitric oxide (FeNO) - indicator of airway eosionphilia (but can be raised in conditions other than asthma)

Peak flow variability - diurnal variation in peak expiratory flow above 20%

(obstructive spirometry –> BDR –> FeNO –> asthma diagnosis)

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21
Q

What does a FeNO test reveal in asthma?

A

Confirm eosinophilic airway inflammation to support an asthma diagnosis in patients

above 40ppb in adults
above 35 ppb in children

22
Q

What does a FeNO test reveal in asthma for adults?

A

above 40 ppb

23
Q

What does a FeNo test reveal in asthma for children?

A

above 35 ppb

24
Q

What does a FeNo indicate in a patient with diagnosed asthma?

A

A non-invasive biomarker of the airway (Type-2 inflammation) – can be used to determine adherence and steroid response.

An elevation in NO is indicative that the asthma is not adequately controlled or unresponsive to steroids.

25
What does a spirometer with a bronchodilator reversibility test reveal?
Defined improvement >12% in FEV1 | offered to adults with <70% FEv1/FVC ratio to confirm asthma diagnosis
26
What is the defined improvement with the administration of a bronchodilator in asthma?
>12%
27
What does an FBC reveal in asthma?
Eosinophillia (in acute asthma attacks bloods can show reason precipitating attack e.g. neutrophilia in infection or raised CRP if severe infection)
28
What spirometry findings are associated with asthma FEV1/FVC?
FEV1/FVC <70% with bronchodilator reversibility
29
Which cells are implicated in the pathophysiology of asthma?
Mast cells and basophils IgE mast cell degranulations Eosinophil
30
What is the four pathophysiology steps in asthma?
Epithelial airway damage Vascular smooth muscle hypertrophy Airway hyperesponsiveness Mucous plugging Reversible airway obstruction with intact lung parenchyma
31
What is the presenting complaint for asthma?
SOB Dry cough Chest tightness Variability of symptoms Diurnal - worse at night + early in morning Wheeze Atopic disorders (Food allergies, eczema and hayfever)
32
When are asthma symptoms worse during the day?
During the night + early in morning
33
What is the triad of atopy (asthma)?
Hay fever Food allergy Eczema
34
Which conditions make asthma worse?
GORD - reflux exacerbates asthma
35
What questions asked for suspected asthma?
Are the problems always there? Do you wake up at night breathless or coughing? Are there noises when they breath? Any triggers? Dusty environment, pets, smoking, exercise Previous hospital admission and care?
36
What test is used to assess asthma control?
Asthma control test (ACT)
37
What is the FEV1/FVC ratio or asthma?
<70%
38
What two investigations are indicated for the diagnosis of asthma?
FeNO Spirometry - FEV1/FVC <70% with bronchodilator reversibility >12%
39
What is the first-line management for asthma?
Salbutamol (SABA) | Address triggers, smoking cessation inhaler technique + adherence
40
What colour is a reliever inhaler?
Reliever- SABA -Blue
41
What colour is a preventor inhaler?
Brown - Low dose ICS
42
What are the management aims of asthma treatment? what happens when these are not met?
No daytime symptoms or night time waking due to asthma No asthma attacks or need for rescue medications No limitations on activity Normal lung function Minimal side effects escalate treatment to the next step above when symptoms are not adequately controlled but use the lowest dose of ICS possible make sure patient is trained in correct inhaler technique and confirm compliance
43
What medication is added if Low Dose ICS and SABA is unresponsive in asthma?
Long acting beta 2 agonist (LABA)
44
name leukotriene receptor anatagonist example
montelukast
45
Name an ICS?
beclometasone, budesonide, ciclesonide, fluticasone, and mometasone
46
Name a LABA
salmeterol | formoterol
47
Name a SAMA
ipratropium bromide | tiotropium,
48
What is the step-up management despite the use of LABA
Add Leukotriene receptor antagonist or increase ICS dose
49
What is the management for an acute exacerbation of asthma?
Oxygen Salbutamol - 5mg nebulised, repeat 15-30mins Prednisolone - 40-50mg oral if poor initial response to SABA or acute severe or life-threatening asthma Ipratropium bromide - 0.5mg, nebulised (if no improvement then escalate to senior help) acute severe asthma + had poor initial response to SABA Magnesium sulphate - IV Last resort by senior doctors: Aminophylline - IV ITU intubation + ventilation
50
what are the inhaler colours
blue --> SABA (Reliever) brown --> ICS (preventer) other colours are generally combinations see: https://ggcmedicines.org.uk/media/uploads/prescribing_resources/inhaler_id_chart_-_1701.pdf note: MART is maintenance + reliever therapy which is ICS + LABA in a single inhaler

Yr3 - Resp Conditions (6 decks)

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