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Flashcards in Asthma Deck (14):
1

Increased levels of which cells are found in asthma?

Mast cells (in epithelium, smooth muscle, mucous glands)
Eosinophils (in bronchial wall & secretions )
Lymphocytes & Dendritic cells (in mucous membrane)

2

What are the symptoms of asthma?

Episodic signs and symptoms
- dyspnoea
- non-productive cough (often nocturnal)
- triggers (e.g. cold air, aerosols)
- associated atopy (rhinitis, conjunctivitis, eczema)
Family History

3

Signs in examination of asthma

Tachypnoea
Audible wheeze
Hyper inflated chest
Hyperesonant on percussion
Decreased air entry

4

Investigations for asthma

Peak flow (decreased)
Spirometry (decreased FEV, FVC & FVC/FEV)
Exercise tests
Histamine/allergen inhalation - provacation
Reversibility to inhaled salbutamol

5

Step 1 of asthma management

SABA when required
e.g. Salbutamol

6

When do you step up to step 2 in asthma treatment?

When using SAB more than once daily or nighttime symptoms

7

Step 2 of asthma management

Add standard dose inhaled steroid
e.g. Beclomethasone

8

Step 3 of asthma management

Add LABA (e.g. Salmetarol)
If adequate but still not controlled increase beclomethasone dose
If LABA has no effect stop it and review diagnosis

Leukotriene receptor antagonist or oral theophylline may be tried

9

Step 4 of asthma management

Consider trials of:
- beclomethasone up to 2000ug/day
- Modified release oral theophylline
- modified release oral B2 agonist
- Oral leukotriene receptor
(Alongside previous therapy

10

Step 5 of asthma management

Add regular oral prednisolone (low as possible)
Continue with high dose inhaled steroid
Refer to asthma clinic

11

Define severe asthma attack

Inability to complete sentences
pulse > 100bpm
RR > 25/min
PEF 35 - 50% predicted

12

Define life threatening asthma attack

Silent chest
Confusion
Exhaustion
Cyanosis
Bradycardia
PEF >33% predicted

13

Acute management of asthma

O - oxygen 100% non rebreather mask
S - salbutamol 5mg nebulised
H - hydrocortisone 100mg IV or prednisolone 40-50mg PO
I - ipratropium 0.5mg nebulised
T - theophylline IV or Aminophylline IV
M - Magnesium Sulphate 1.2 - 2g IV over 20 mins
E - escalate (anaesthetist)

14

What are the pathological stages of asthma?

Genetic predisposition + trigger
Inflammation
Mucus hypersecretion
Airway remodelling
Muscle hyperactivity