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Respiratory (LECTURE NOTES) > Asthma > Flashcards

Asthma Flashcards

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1
Q

Define asthma

A

A disease characterised by airway inflammation with increased airway responsiveness resulting in airway obstruction

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2
Q

What are the main symptoms associated with asthma

A

Cough, wheeze, shortness of breath

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3
Q

Describe the nature of asthma

A

Dynamic and heterogeneous clinical syndrome that has a number of different patterns and which may progress through different stages

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4
Q

How much of the adult population had asthma in the UK

A

7%

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5
Q

Patients with asthma are also likely to have a high prevalence of what 3 conditions

A

Rhinitis
Urticaria
Eczema

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6
Q

What environmental change has occurred resulting in a higher prevalence of asthma

A

A more modern, urban, economically developed society

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7
Q

What 3 allergens are associated with asthma

A

House dust mites
Pet -derived allergens
Cigarette smoke

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8
Q

What 3 allergens are associated with asthma

A

House dust mites
Pet -derived allergens
Cigarette smoke

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9
Q

What type of Ig antibody is found in high levels

A

IgE

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10
Q

What are the effects of the mediators in response to an allergen

A

Contraction of the airway smooth muscle and increased vascular permeability and stimulation of airway mucus secretion

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11
Q

What do Th2 cells produce

A

Pro-inflammatory interleukins

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12
Q

What do Th1 cells produce

A

Cytokines

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13
Q

What is the function of Th2 cells in asthma

A

Enhancing IgE synthesis and eosinophil and mast cell function

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14
Q

What is the function of Th1 cells in asthma

A

to down-regulate the atopic response

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15
Q

Describe what happens to the wall of the airway in asthma

A

It is thickened by oedema, cellular infiltration, increased smooth muscle mass and glands

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16
Q

What occurs which leads to fibrosis of the airway wall

A

Airway remodelling

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17
Q

What is a prominent feature of acute severe asthma

A

Mucus plugging o the lumen of the airway

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18
Q

Define atopic asthma

A

asthma occurring in relation to inhalation of environmental antigens in a susceptible person

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19
Q

Define non-atopic asthma

A

asthma occurring without any definable relationship to an environmental antigen

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20
Q

What is the difference in airway inflammation of atopic and non-atopic asthma

A

They are identical pathologically- the inflammatory cascade of asthma can be initiated by a variety of different factors in different patients

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21
Q

What is meant by morning dipping

A

Peak expirratory flow (PEF) measurements are worse early in the morning

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22
Q

What is meant by nocturnal asthma

A

Symptoms such as cough and wheeze often distrubing sleep

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23
Q

What does eosinophilic bronchitis usually present with

A

A chronic cough

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24
Q

Describe the characteristic features on examination of patients with asthma

A

Diffuse bilateral wheeze
Prolonged expiratory phase
lower costal margin paradox

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25
What are signs of a severe episode of asthma
``` Tachycardia tachypnoea cyanosis use of accessory muscles features of anxiety and general distress ```
26
What might chronic severe childhood asthma cause
chest deformity with the lower rib cage being pulled inwards
27
What might chronic severe childhood asthma cause
chest deformity with the lower rib cage being pulled inwards
28
What might be the reasonable next step if a careful history and clinical assessment strongly suggest the diagnosis of asthma
Trial of asthma treatment
29
What should be done if there is not a clear response to treatment
Reconsider the diagnosis
30
Confirmation of the diagnosis hinges on what?
demonstration of airflow obstruction that changes over short periods of time, either spontaneously (variability) or in response to treatment (reversibility)
31
What does spirometry allow that PEAK flow doesnt
a clearer confirmation of airflow obstruction than the PEF
32
What confirms airway obstruction
A reduced FEV/VC ratio (usually less than 0.7)
33
What is the standard starting does of salbutamol and when is spirometry repeated
200ug | 15-20 minutes after
34
What is an alternative approach to test reversibility
A 6 weeks trial of inhaled corticosteroid (200ug of beclametasone) or a 2 week trial of an oral steroid (30mg/day prednisolone)
35
An improvement in FEV1 of what volume strongly suggests asthma
>400ml
36
What happens to the total lung capacity in asthma
usually increased as a manifestation of hyperinflation and residual volume is elevated indicating air trapping
37
What is airway responsiveness
A measure of the general "irritability" of the airways, the degree to which bronchoconstriction develops in response to physical or chemical stimuli
38
In exercise testing, what is highly suggestive of asthma
Post exercise fall in FEV1 or spirometry before and after 5-10 minutes of exercise
39
How can the degree of airway responsiveness be measured precisely in the lab
Methacholine provocation tests
40
What is involved in the methacholine provocation test?
the patient will inhale increasing doses of nebulised methacholine or histamine, starting at a very low dose and serial spirometry is performed
41
What is involved in the methacholine provocation test?
the patient will inhale increasing doses of nebulised methacholine or histamine, starting at a very low dose and serial spirometry is performed
42
What is the most common test for hypersensitivity
Skin prick test to identify atopy and to detect particular sensitivity to a specific antigen with a view to exclusion of exposure where possible
43
What is a positive result to a skin test
A weal with a surrounding erythematous flare at about 15 minutes
44
What is a means of measuring the level of circulating IgE specifically directed towards a particular antigen
Radioallergosorbent testing (RAST)
45
What are 3 really good questions to ask during an asthma review consultation
In the last month/ week have you had difficulty sleeping due to your asthma? Have you had your usual asthma symptoms during the day? Has your asthma interfered with your usual daily activities
46
What are 3 really good questions to ask during an asthma review consultation
In the last month/ week have you had difficulty sleeping due to your asthma? Have you had your usual asthma symptoms during the day? Has your asthma interfered with your usual daily activities
47
What two drugs should be avoided in asthamtics
B Blockers and aspirin
48
What is used to relieve symptoms of bronchoconstriction
SABAs
49
What is used to treat the underlying chronic inflammatory process in asthma
Inhaled corticosteroids
50
What is sometimes used with a corticosteroid
LABA
51
How do SABAs work?
They stimulate B adrenoceptors in the smooth muscle of the airway producing smooth muscle relaxation and bronchidilation
52
How long does it take SABAs to work and how long do they work for
15 minutes | 4-6 hours
53
What are the side effects of SABAs
Tremor | Palpitations
54
If a patient needs their reliever more than 3 times in a week what should the clinician do?
Increase the patients maintenance therapy
55
When do LABAs work
After 12 hours
56
When is LABA use recommended
with the use of inhaled corticosteroids
57
As a result, what is often used now in asthma management
Combination inhalers
58
What can be used as both a reliever and a maintenance therapy
Symbicort
59
How do anti-muscarinic bronchodilators work
They produce bronchodilation by blocking the bronchoconstrictor effect of the vagal nerve stimulation on bronchial smooth muscle
60
How do Theophyllines work
They inhibit the metabolism of cAMP by the enzyme phosphodiesterase
61
What are some side effects of theophyllines
``` Nausea vomiting headache tachycardia malaise ```
62
What are some side effects of theophyllines
``` Nausea vomiting headache tachycardia malaise ```
63
How does magnesium work in asthma
Acts as a smooth muscle relaxant
64
What is considered a low dose of inhaled steroids
below the equivalent of 800ug/day
65
What are some side effects of inhaled steroids
Oropharyngeal candidiasis or hoarseness of the voice
66
What can reduce the hoarseness
Using a spacer device and taking a drink of water after use
67
What is sodium cromoglycate
A preventative inhaled treatment that has a number of anti-inflammatory actions including stabilisation of mast cells
68
Is sodium cromoglycate more or less effective than inhaled steroids
Less
69
Is sodium cromoglycate more or less effective than inhaled steroids
Less
70
WHen would oral steroid treatment be needed
To control exacerbations of asthma
71
How long is a typical oral steroid treatment
about 7 days
72
How do leukotriene receptor antagonists work
They block the effects of cysteinyl leukotrienes - which are metabolites of arachidonic acid with bronchoconstrictor and pro-inflammatory actions
73
What is Anti-IgE treatment
a monoclonal antibody that binds to IgE
74
What is control of asthma defined as
``` No daytime symptoms No night -time wakening due to asthma no need for reliever medication no exacerbations no limitations on activity including exercise normal lung function >80% predicted minimal or no side effects of treatment ```
75
Why is the inhaled route for bronchodilator and corticosteroid drugs preferred
The drugs can be delivered directly to the airways reducing the risk of systemic adverse effects
76
Why is the inhaled route for bronchodilator and corticosteroid drugs preferred
The drugs can be delivered directly to the airways reducing the risk of systemic adverse effects
77
How are metered dose inhalers drugs metabolised
by first pass metabolism in the liver
78
What can be used to overcome metered dose inhalers
Large volume spacer devices
79
What does a large volume spacer result in
Reduced need for coordination of inspiration and actuation of the inhaler Improves delivery of the drug to the lower airways
80
How often should spacer devices be replaced
Yearly
81
What are the 4 signs of an acute severe asthmatic attack
PEF 33-50% of best or predicted RR 25 or more HR is 110 or more Inability to complete sentences in one breath
82
What are some clinical signs of life threatening asthma
``` Altered conscious level exhaustion arrhythmia hypotension cyanosis silent chest poor respiratory effort ```
83
What are some investigations that should be done for a severe asthmatic attack
ABGs U&E ECG CXR

Respiratory (LECTURE NOTES) (19 decks)

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