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YR3: RESPIRATORY LO's > Asthma > Flashcards

Asthma Flashcards

1
Q

Define Asthma and describe what it is characterised by

A

chronic airway inflammation
Variable reversible expiratory airflow limitation
Airway hyper-responsiveness

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2
Q

Describe the genetic aetiology/ risk factors of asthma

A

FHx

Atopy (T lymphocytes drive production of IgE on exposure to allergens)

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3
Q

Describe 7 environmental aetiology/ risk factors of asthma

A 
House dust mites 
Pollen 
Pets  
Cigarette smoke  
Viral respiratory tract infections  
Aspergillus fumigatus spores  
Occupational allergens
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4
Q

Summarise the epidemiology of asthma

A

10% of children
5% of adults
Prevalence increasing

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5
Q

List 4 presenting symptoms of asthma

A

Episodic hx
Wheeze
Breathlessness
Cough (worse in the morning + at night)

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6
Q

What are 5 precipitating factors of asthma?

A 
Cold  
Viral infection  
Drugs (e.g. b-blockers, NSAIDs) 
Exercise  
Emotions
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7
Q

What should you ask about when taking history of possible asthma?

A

Previous hospitalisation due to acute attacks- indicates severity of asthma
Hx of atopic disease: allergic rhinitis, urticaria, eczema

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8
Q

What are 5 signs of asthma on examination?

A 
Tachypnoea 
Use of accessory muscles  
Prolonged expiratory phase  
Polyphonic wheeze  
Hyperinflated chest
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9
Q

List 4 signs a severe asthma attack

A

PEFR < 50% predicted
Pulse > 110/min
RR > 25/min
Inability to complete sentences

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10
Q

List 7 signs of a life-threatening asthma attack

A 
PEFR < 33% predicted  
Silent chest  
Cyanosis  
Bradycardia  
Hypotension  
Confusion  
Coma
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11
Q

What 8 investigations are performed in acute asthma attacks?

A 
Peak flow  
Pulse oximetry  
ABG  
CXR: exclude ddx (e.g. pneumonia, pneumothorax) 
FBC: raised WCC if infective exacerbation  
CRP  
U+Es 
Blood + sputum cultures
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12
Q

What 4 investigations are performed for chronic asthma?

A

Peak flow monitoring: often shows diurnal variation with a dip in the morning
Pulmonary function test
Bloods: Eosinophilia, IgE level, Aspergillus antibody titres
Skin prick tests: helps identify allergens

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13
Q

Describe the management of acute asthma attacks

A 
ABCDE, Resuscitate  
Monitor O2 sats, ABG + PEFR 
High-flow O2, Salbutamol nebuliser, Ipratropium bromide  
Nebulized steroid therapy
If no improvement, nebulize magnesium sulphate, or IV aminophilline / salbutamol
Anaesthetic help if PCO2 increasing
Treat cause: infection etc.
May need ventilation in attacks
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14
Q

Why is a normal PCO2 is a BAD SIGN in a patient having an asthma attack?

A

Patient should be hyperventilating + blowing off their CO2, so PCO2 should be low
A normal PCO2 suggests patient is fatiguing

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15
Q

When and how do you discharge a patient after an acute asthma attack?

A

When PEF > 75% of predicted, discharge.
Stable on discharge medication for 24h
Check inhaler technique + appropriate regime, arrange follow up.

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16
Q

Describe the stepwise management of chronic asthma

NICE guidelines

A
  1. SABA (salbutamol)
  2. SABA + ICS
  3. SABA + ICS + LTRA
  4. SABA + ICS + LTRA + LABA
  5. a) + Increase ICS to mod-high dose
  6. b) + slow-release theophylline or Long acting muscarinic receptor antagonist
    • Oral steroids
17
Q

Give 3 pieces of advice to asthmatic patients

A

Teach proper inhaler technique
Explain importance of PEFR monitoring
Avoid provoking factors / allergens

18
Q

List 6 possible complications of asthma

A 
Growth retardation  
Chest wall deformity (e.g. pigeon chest)  
Recurrent infections  
Pneumothorax 
Respiratory failure  
Death
19
Q

Describe the prognosis of asthma

A

Many children improve when older

Adult onset is chronic.

20
Q

What 3 physiological factors contribute causes difficulty breathing air out of the lungs?

A

Bronchoconstriction
Airway wall thickening
Increased mucus

21
Q

Give an example of each drug used in asthma

A 
SABA: Salbutamol
ICS: Beclometasone, Budesonide
LABA: Formoterol
LTRA: Montelukast
Oral steroid: Prednisolone
22
Q

What is the MOA of SABAs + LABAs?

A

Relaxes smooth muscle + dilates bronchioles

23
Q

What is the MOA of ICS?

A

Suppress airway inflammation + reduce airway hyper-responsiveness

YR3: RESPIRATORY LO's (16 decks)

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