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Flashcards in Asthma Deck (19):

What is Asthma ?

C: chronic inflammatory airway disease
R: reversible airway obstruction
A: airway hypersensitivity
B: bronchial inflammation


Describe the symptoms of asthma

Symptoms may be variable but intermittent and symptoms WORSE in the early morning: WIND
1) Wheeze (not always present if patient is well)
2) Interferes with everyday life and activities such as exercise
3)Nocturnal cough classically but may occur in the early morning
4) Dyspnoea/SOB


Describe early onset asthma

Early onset/ extrinsic asthma = childhood
1) occurs in younger patients or children with atopy (extrinsic alveolitis/rhinitis)
2) positive skin prick tests to common allergens and IgE levels may be raised
3) asthma may re-occur


Describe late onset asthma

Late onset/intrinsic asthma= adulthood

1) occurs in middle aged individuals > 30 years of age
2) no history of atopy
3) negative skin prick tests and IgE levels may be normal
4) remission is RARE


State the precipitating factors of asthma

Environmental factors= ASTHMA
Allergens (grass pollen) and fury animals (cats/dogs/some birds)
H-House dust mite
M- ?
Atmospheric pollution

Infection (viral)
Cold air and chemical exposure: occupation ( baking, paint workers, etc)
Exercise and emotion
Drugs: NSAIDS, particularly aspirin and B-Blockers
S: stress and GORD


State the main symptom of an acute asthma attack 😭

Marked SOB


What does a PEF<50% and 33% indicate?

PEF < 50%: severe asthma
PEF < 33%: life threatening


What are the 3 Signs of an acute asthma attack ?

1) tachycardia
2) pulsitile paradox ( sudden drop in BP leading to impalpable pulses)
3) feeble respiratory effort


What are the 3 signs of a severe asthma attack ?

1) bradycardia
2) cynaosis
3) feeble respiratory effort (quiet chest)


In a severe asthma attack, which is found on percussion of the chest ?

Hyper resonance


State one important feature of a severe asthma attack



Describe the blood gases for the following:
-Stable asthma
-mild asthma attack/exacerbation
-Severe asthma attack

-Stable asthma: normal
-Mild asthma/exacerbation: respiratory alkalosis. In a mild asthma attack, you hyperventilate leading to a decrease in CO2, leading to a respiratory alkalosis. If O2 is low may lead to type 1 respiratory failure
-severe asthma attack: Respiratory acidosis and type 2 respiratory failure. In a severe asthma attack there is decreased/feeble respiratory effort so the lungs cant remove CO2 and get in O2. Increase in CO2 ( resp acidosis) + low O2= type 2 Respiratory Failure


Which 4 conditions show an obstructive deficit ?

1. Asthma
4. Cystic fibrosis


What does an obstructive deficit create and what happens to FEV1,FVC and the FEV1/FVC ratio ? 😭

An obstructive pattern creates resistance to expiratory flow. As a result, the patient cannot breathe out quickly. FEV1 decreases, FVC is normal or increased and FEV1/FVC ratio is decreased <70%.


What two conditions show a restrictive deficit ?

Pulmonary fibrosis and interstitial lung disease


What does a restrictive deficit restricts and what happens to FEV1,FVC and the FEV1/FVC ratio ?

A restrictive deficit restricts the capacity and elasticity of the lungs, so less air is retained in the lungs and the patient cannot breathe out quickly. FEV1 decreased, FVC 1 deceased more than FEV1. FEV1/FVC ratio: normal or increased > 70%


Look at flow diagram and answer ABGS



Describe the pathology of asthma

The initial pathology involves type 1 hypersensitivity reaction.
1. Th2 cells activate plasma cells to release antibodies alongside eosinophil release of inflammatory mediators
2) These cross-link antigens to activate mast cells to release inflammatory mediators
3) Type 4 hypersensitivity may occur simultaneously Th2 cells may activate smooth muscle (SM) receptors
4) Lastly, bronchial SM contraction, bronchial oedema and mucus plugging occur.


Describe the morphology of asthma

Histological changes reflect combination of allergic reaction & muscular hypertrophy
1. Mucus secreting glands present & viscous secretion may be seen to contain eosinophils (with Charcot-Leyden crystals), Curschmann's spirals (white granules) + desquamated epithelium cells
2. submucosa appears oedematous & vessels congested
3. SM is hypertrophied and basement membrane is thickened and hyalinated.