Asthma Flashcards
What are the DEFINING CHARACTERISTICS of ASTHMA?
1) Airway Inflammation Mediated by the Immune System (> Responsiveness to Various Stimuli)
2) Widespread Narrowing of the Airways due to Constriction of Bronchial Smooth Muscle
3) Changes in Severity, Spontaneously or in Response to Therapy
What is the EPIDEMIOLOGICAL SIGNIFICANCE of ASTHMA PREVALENCE?
1) 5.4 million Receiving Treatment
2) Functional Consequences, i.e. Limited Capacity for Daily Activities and Exercise Tolerance
3) Financial Burden on NHS
What are the MAIN CAUSES of ASTHMA?
1) Genetic - Atopy
- Inherited Tendency to IgE Response to Allergens
2) Occupational Exposure, i.e. Grains, Drugs, Crustaceans, Lab Animals, etc
3) Smoking
- Maternal Smoking and ‘Grandmother Effect’
4) Obesity
5) Diet
What are the POSSIBLE RISK FACTORS for ASTHMA?
1) < Exposure to Microbes
2) Indoor Pollution: Household Chemical Exposure
3) Environmental Allergens, i.e. House Dust Mites; Pets; Grass Pollen
What are some of the SYMPTOMS of ASTHMA?
1) Wheeze
2) Intermittent Dyspnoea
3) Chest Tightness/Pain
4) Dry Cough
5) Occasional Sputum Production
6) Paroxysmal Nocturnal Cough
What are some of the TRIGGERS for ASTHMA SYMPTOMS?
1) Exercise
2) Cold Air
3) Smoke
4) Perfume
5) URTIs
6) Pets
7) Grass Pollen
8) Food
What are some of the SIGNS of ASTHMA?
1) Tachypnoea
2) Hyperinflated Chest
3) Polyphonic Wheeze
4) Hyper/ > Resonance to Percussion
5) < Air Entry
What are the ESSENTIAL INVESTIGATIONS for ASTHMA?
1) Spirometry
2) Bronchodilator Trial
3) Bronchial Provocation - Exhaled Nitric Oxide
What would be the EXPECTED FINDINGS for an ASTHMATIC on SPIROMETRY?
Obstructive Pattern
< FEV1 ( <80%)
< FEV1:FVC ( < 70%)
OR
Normal (due to Variability)
- Monitor with Peak-Flow (Could be Occupational Cause)
What would be the EXPECTED FINDINGS for an ASTHMATIC following BRONCHODILATOR use?
Reversibility of Symptoms Following SABA and Oral Corticosteroid use
What other USEFUL INVESTIGATIONS can be used in the DIAGNOSIS of ASTHMA?
1) CXR
2) Skin Prick Test (Atopic Status)
3) Serum Immunoglobulins (Total and Specific IgE)
4) FBCs (Eosinophilia)
5) ABGs (Acute Exacerbations)
What would be the EXPECTED FINDINGS following CXR of an ASTHMATIC?
Hyperinflated and Hyperlucent Lung Fields
What are the SIGNS of ACUTE SEVERE ASTHMA?
1) Unable to Speak/Complete Sentences
2) Tachycardia (HR > 110)
3) Tachypnoea (RR > 25)
4) PEF: 33-50% Predicted or Best
5) < SpO2 (approx. 92%)
6) < PaO2 (approx. 8kPa)
7) Confusion
What are the AIMS in the TREATMENT of ASTHMA?
1) Minimise Symptoms during the Day and Night
2) Minimise ‘Reliever’ Use
3) No Exacerbations
4) No Limits on Physical Activity
What is the STEPPED APPROACH to treating ASTHMA?
1) Low Dose Inhaled Corticosteroids (ICS) (Preventer) + As Required, Short-Acting Beta-2 Agonist (Reliever)
2) Long Acting Beta-2-Agonist (LABA) + ICS
3) + or - LABA, depending on symptoms, and > ICS dose
4) Consider Adding Long-Acting Leukotriene Receptor Antagonist (LTRA), i.e. Montelukast, or Theophylline + ICS
5) Oral Steroids, i.e. Prednisolone + ICS
