Asthma Flashcards by Sarah Anderson

What is the definition of asthma

A disease characterised by an increased responsiveness of the trachea and bronchi to various stimuli and manifested by a widespread narrowing of airways & bronchial inflammation, that changes in severity either spontaneously or as a result of therapy; resulting in episodic wheeze and/or cough

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What is the two stand out features of asthma

variable and reversible

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How is asthma characterised

Wheeze

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What are some examples of the multiple triggers

Exercise
Allergen
Cold weather
smoke
perfume
Upper Respiratory Tract (URT) infections,
pets, trees, grass pollen, food, aspirin.

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What is the Pathophysiology of asthma

airway inflammation mediated by immune system

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What are the proven risk factors of asthma

and other possible risk factors

Genetics
Occupation
Smoking

Possible:

Obesity 
Diet 
Reduced microbe exposure
   (farm children less likely due to previous exposures)
Chemical products 
Environmental exposures 
Abnormal lungs

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What genetic tendency can be inherited that could trigger asthma?

An atopic tendency - which increase IgEs response to allergens

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Is it maternal or paternal atopy genetics that is most significant in an IgE to respond to an allergen

What are the two groups of genes that increase atopic tendencies development of asthma

Maternal - epigenetic modification of oocytes

Immune response geneses (IL-4, IL-5, IgE)
Airway response genes (ADAM33)

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What is the affects of maternal smoking during pregnancy

Decreases FEV1

Increases airways responsiveness
(therefore increase the risk of asthma/wheezy illness development)

Increases severity

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Does environmental exposure directly cause asthma?

No, because the atopy genetics need to be previously present for environmental factors to increase the sensation and trigger asthma

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What is the symptoms of asthma

wheezing attacks
episodic shortness of breath (dyspnoea)
chest tightness 
cough – paroxysmal(outburst)/ dry 
sputum (occasional)

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What are other examples of airflow obstruction diseases

COPD (irreversible AFO)
bronchiectasis
bronchiolitis
Cystic Fibrosis

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What are examples of localised airflow obstructions

inspiratory stridor (obstruction of windpipe)
tumour
foreign body

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What are the main areas of concern when diagnosing asthma during a history taking

Past medical history
Current drugs
Family medical history
social medical history

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What signs on examination prove its probably not asthma

Clubbing
cervical lymphadenopathy
Stridor (harsh or grating sound)- upper airway obstruction
Asymmetrical expansion
Dull percussion note (lobar collapse or effusion)
Crepitations- crackling/rattling sound (bronchiectasis, CF, alveolitis, LVF)

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What are the essential investigations carried out for asthma looking for

Airflow obstruction

Variability and/or reversibility of airflow obstruction

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In a spirometry:
What does the FVC investigate
What is the FEV1/FVC ratio that shows the airway obstruction

Lung volume

<70%

If the FEV1/FVC is <70% what is the predicted FEV1

<80%

What is the factor that can differentiate between COPD and asthma

Reversibility

in spirometry is the results show an airway obstruction what are the further testing that occurs to differentiate it from COPD

Full pulmonary function test
Test with B2 agonist
Test with steroids

What is the full pulmonary function tests carried out to exclude COPD and emphysema

Breathing in helium to show that there is an increase in the residual volume and TLC as there is a problem in expiring

Breathing in CO to prove that there is no problem in gas exchange therefore the alveoli are still efficient

NO - people with asthma will have a higher level of NO in there breath

What does the test of the B2 agonist Salbutamol and steroid test prove

If the bronchodilaiton is reversible

and the reversibility with steroids differentiates asthma from COPD

When would no reversibility be shown when using salbutamol inhaler

When there is no bronchocontriction or the bronchocontriction is to severe

What is the problem with spirometry

Therefore what needs to be investigated if the results are normal

Lacks specificity

the variability of the potential asthma
- as this can be a problem in diagnosing

What tests are carried out to asses the variability

Peak flow monitoring, twice daily for two weeks

What is investigations for asthma

oChest X Ray- hyperinflated / hyperlucent lungs - (no effusion, collapse, opacities, interstitial changes) oSkin prick testing or total and specific IgE (both atopic status)- put allergens under skin and check for wheal and flare reaction oFull blood count – eosinophilia (atopy) oArterial blood gases (PaCO2/PaO2) - if in doubt o Full Pulmonary function test (He/CO/NO) o Spirometry o Test reversibility (B2 agonists/Steroids)

What tests need to be taken to asses the severity of acute asthma

o Ability to speak- whether patient can talk to you o Heart rate-pulse o Respiratory rate o PEF- peak expiratory flow o Oxygen saturation / Arterial blood gases

Above what heart rate and reparation rate shows a severity in asthma

>110 | >25

What is the signs asthma has become life threatening and near fatal

hyperventilating and brachycardic | Raised PaCO2 levels

How long till you re-measure the spiriometry in a brobchodilation salbutamol test and after steroid treatment

15 minutes 2 weeks

What is needed for conformation of asthma

``` Serial peak flow readings 2 hourly best: 5/d minimum 2 pairs of exposed/unexposed periods (at least) Antibodies Bronchial constriction ```

What do paediatric asthma and adult asthma have in common? What is the differnences

1. Symptoms 2. Common occurrence 3. Same triggers 4. Same treatment 5. Same pathology Severe asthma = childhood Occupational asthma = adult hood

What triggers the onset of asthma

1. Genes 2. Inherently abnormal lungs 3. Early onset atopy – syndrome characterised by tendency to be hyper allergenic 4. Later exposures - rhinovirus - exercise - smoking

What is the carrying differences and inconsistencies of asthma in varying patients

``` “Transient” vs persistent - short term/long term Different severities Different age at onset Heterogeneity in response Different triggers ```

What is the differences in children's airway and what outcome does this have on the sound of the wheeze

Children’s airways are smaller | and more likely to be musical

What are respiratory conditions that are mistaken as a wheeze

rattle - fluids such as saliva and bronchial secretions accumulating in the throat and upper chest stertor- partial obstruction of airway above the level of the larynx = heavy snoring or gasping stridor - Obstructed windpipe or larynx resulting in loud, harsh, high pitched respiratory sound

What treatment is used to measure if the predictted asthma will respond

inhaled cortico steroids for 2 months

What is the treatment for infrequent episodes of a wheeze

Salbutamol

Over what age is the symptoms presented most likely to be asthma What is the likely diagnosis for baby under 18 months

age 5 Infection

What are the four different types of coughs that can be misdiagnosed as asthma

Bronchitis - loose rattly cough - noisy breathing Pertussis (whooping cough) - coughing fits - vomiting colour change Habitual cough Tracheomalacia - Life long cough

If a wheeze is not present, the cough is moist and it responds to antibiotics, what is the diagnosis?

Bacterial bronchitis