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Flashcards in Asthma Deck (19)
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1
Q

Definition of asthma

A

Disease characterized by recurrent attacks of breathlessness and wheezing, which vary in severity and frequency from person to person

2
Q

Bronchoconstriction

A

Contraction of the smooth muscle in the bronchial wall

3
Q

Bronchial secretions and plugs of mucus

A

Due to inflammation of the bronchial wall

4
Q

Atopy

A

Tendency to form IgE antibodies to allergens (such as pollen, house dust mites or animals).

Often associated hay fever or eczema in the personal or family history

5
Q

Risk factors

A
Genetics
Smoking
Obesity
Pollution
Occupational asthma
6
Q

Symptoms

A

Cough
Wheeze
Breathlessness

The symptoms are episodic. They are often worse at night eg 3-4 am, or after exposure to triggers such as exercise or infection. There is often a feeling of tightness in the chest

7
Q

Diagnosis

A

The history is crucial

Past medical history (previous wheezing illness, hay fever, eczema), family history (of any atopic disease), and social history (occupation, pets) can provide clues

Physical examination may be normal except during an attack

8
Q

Investigations

A

The chest X-ray is often normal, but may show hyperinflation

There may be an increased eosinophil count in the blood

Skin prick or blood tests may confirm allergies

Lung function tests may show airflow obstruction, but may be normal between attacks

9
Q

Test of lung function

A

Does obstruction vary over time?
- peak flow monitoring
Is it reversible?
- with bronchodilators or a course of steroids
15% improvement from baseline
Would a bronchial challenge test help?
- if the story suggests asthma, but lung function is normal

10
Q

FeNO

A

Measure of airway eosinophilic inflammation

11
Q

Management of asthma

A

relievers

  • beta 2 agonists (eg
    salbutamol,terbutaline).
    - theophylline, anticholinergics
12
Q

Patients with difficult asthma treatments

A

Desensitisation to proven inhalant allergens

Monoclonal anti-IGE antibody injections (omalizumab)

Immunosuppressant therapy (apart from corticosteroids) eg methotrexate

Bronchial thermoplasty

13
Q

Treatment compliance/adherence - unintentional

A

Misunderstanding
Poor inhaler technique
Language
Forgetfulness, stress

14
Q

Treatment compliance/adherence - intentional

A

Concern about side-effects

Denial

15
Q

Personal asthma action plan

A

List daily medication to take and explain why

List which asthma triggers to avoid

List indicators, such as increasing cough, or deterioration of asthma

List names and doses of medication to be taken to treat worsening asthma

List indicators of how and when to seek medical attention

16
Q

Management of asthma - features of severe asthma

A

PEF 33-50% best or predicted
Can’t complete sentences
Respiratory rate >25 breaths/min
Pulse >110 beats/min

17
Q

Management of asthma - life threatening features

A

Hypoxia (O2 sats <92%)
Silent chest, poor resp effort
Bradycardia or hypotension
Exhaustion, confusion, coma

18
Q

Management of asthma

A

Oxygen
Corticosteroids - prednisolone 40-60 mgs orally (IV hydrocortisone if unable to take orally)
Nebulised bronchodilators – salbutamol + ipratropium
If poor response, IV MgSO4, salbutamol or aminophylline
Exceptionally, ventilation (IPPV) is required

19
Q

Hospital discharge

A
Diurnal variation of PEF < 25%
Support/safety at home
Education
Personalised written asthma action plan
Follow up