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Asthma Flashcards

1
Q

What is asthma

A

Chronic type 1 hyper-responsiveness of airway
Leading to inflammation and obstruction
Inflammation - mucous / muscle hypertrophy and contraction
Variable - 20% peak flow
Reversible - bronchodilator
Responds to treatment

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2
Q

What are types of onset of asthma

A 
Infant
Childhood
Adult 
Exertional
Occupational
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3
Q

What causes asthma

A 
Genetics
FH atopic tendency
Atopy - hay fever / eczema / allergy 
Occupation - smoke
LBW
Obesity 
Environment - smoke / pollution
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4
Q

What triggers asthma

A 
Cold air
Exercise
Smoke
Allergen
Virus - URTI
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5
Q

How does asthma present

A 
Wheeze
SOB - trapped
Dry nocturnal exertional cough
Diurnal - typically worse at night 
Tight chest as muscles contract
Worse at night
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6
Q

What are signs of asthma

A 
Hypercapnia
Hypoxia
Cyanosis
Tachycardia
Accessory muscle 
Resp distress
Hyperinflated lungs
Clubbing - chronic hypoxia
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7
Q

When is it NOT asthma

A 
<18 months = VIW
Productive cough 
Stridor (hard inspiratory)
Asymmetrical signs / unilateral 
Dull percussion
Crepitations
No response to RX
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8
Q

How do you Dx asthma

A

No investigation in children

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9
Q

What can you do to aid Dx

A

Trial of ICS

LTRA <5

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10
Q

How do you monitor

A

Peak flow if >5

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11
Q

If child comes into hospital what tests do you do

A

Pulse oximetry
Peak flow if >5
ABG if life threatening but VBG will work
Bloods - FBC, U+E as salbutamol = hypoK, lactate+CRP if think sepsis
CXR if suspect pneumonia / pneumothorax

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12
Q

Why is normal CO2 worrying

A

Hyperventilating so should be low

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13
Q

What are goals of Rx

A

Minimal Sx
Minimal reliever
No attacks
No limitations

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14
Q

How do you measure control

A

SABA / week
Absence from school
Nocturnal Sx / week
Exertional Sx / week

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15
Q

What are general measures

A

Remove trigger

Stop tobacco exposure

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16
Q

What do you do if asthma Dx / suspected

A

SABA as required

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17
Q

When do you step up

A

If SABA
>3 week
Nocturnal
Oral steroid

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18
Q

What do you add

A

8 week trial of Low dose ICS (even if <5 according to NICE)
If Sx resolved but came back after stopped ICS = offer low dose ICS + SABA
If Sx did not resolve consider other Dx
LTRA <5

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19
Q

What do you do if still not controlled

A 
Add LTRA if not controlled after 4-8 weeks 
Stop if one hasn't worked
REFER 
Add LABA to ICS
Increase to medium dose if inadequate 
Add MART
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20
Q

What are additional

A 
REFER 
High dose ICS
Theophylline
Daily steroid
Biologics
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21
Q

If still not responding what should you query / before you add on therapies

A 
Inhaler technique
Dry CI <8 
MDI with spare = gold
Psychological
Compliance
Dx
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22
Q

What are complications

A

Pneumothorax due to increased trapped alveolar pressure

23
Q

What are doses of ICS

A 
Low = 200
High = 400
24
Q

SE of ICS

A

Oral candidiasis
Height and weight
Adrenal insufficiency

25
What is MART
Maintenance AND reliever | Combined ICS and LABA
26
What do you do for children 5-16
Treat as adult
27
What is important in the Hx of acute asthma attack / wheezy child
``` Onset Trigger Any infection that could trigger Specific Sx Any Rx tried Any admissions to hospital or ITU PMH - atopy / infections / asthma / eczema DH - inhalers? Immunisation FH SH - parental smoke Birth / vaccination Hx ```
28
How do you examine
``` A - speaking B - distress / sats / RR. /ausculate C - CRT / BP / HR D - consciousness / pupils / temp / BG E - rash / ENT / abdo ```
29
What is a moderate attack
SpO2 >92 | PEF >50
30
What is a severe attack
``` SpO2 <92 PEF 33-50 No sentences HR >125 RR >30 Accessory neck muscle ```
31
What is lifethreatening
``` SpO2 <92 PEF <33 Resp acidosis Silent chest as airways so small no air Cyanosis Poor resp effort Normal CO2 Exhaustion Hypotension Confusion ```
32
What is fatal
Raised PaCO2
33
What do you do in mild asthma attack
SABA + spacer - 1 puff every 30s up to 10 puffs | +- prednisolone
34
How do you treat moderate asthma attack
``` SABA via nebuliser + prednisolone Add ipatropium bromide (SAMA) Oxygen if low sats Magnesium sulphate Oral steroids early ```
35
How do you treat severe asthma Peak flow <33% Can't complete sentence
``` IV salbutamol IV magnesium sulphate IV aminophylline with anti-emetic IV hydrocortisone Steroids High flow Oxygen Intubate and ventilate if exhausted Chest drain if pneumothorax ```
36
How do you give steroid
``` IN ALL ATTACK Maintenance = inhaled Acute = oral 10mg <5 40mg >5 3 days or until recover Repeat if vomit ```
37
What do you need to do if steroid >14 days
Taper down
38
When do you discharge
Stable 3-4 hours inhaled SABA PEF >75% Sats >94%
39
What must you do before
``` Check inhaler technique Asthma management plan Primary care follow up 1 week Asthma clinic 1 month Continue oral steroid ```
40
Ddx cough
``` Congenital laryngomalacia CF Foegin body Pertussi Croup Pneumonia TB Ciliary dyskinesia Bronchiolitis Habitual cough ```
41
Ddx wheeze
``` VIW Bronchiolitis / LRTI Anaphylaxis FB - monophonic as only in one area GORD HF CF TB Aspiration Tracheo-bronchomalacia Ciliary dyskinesia ```
42
What causes viral induced wheeze
Viral illness RSV = common Persistent / recurrent wheeze but well in between attacks
43
What is multi-trigger wheeze
If not caused by virus
44
How does it present and what makes it more likely than asthma
``` Hx viral illness Wheeze Resp distress Cough SOB Cyanosis If <3 years old, no Hx of atopy and occurs with viral illness ```
45
What does VIW not have
Crackles in chest | NOT LRTI
46
What is RF
Atopy Previous Hx Passive smoke
47
How do you treat VIW
None if mild SABA (10 puff) Inhaled steroid -bexamethasone if recurrent
48
When do you give oral pred
If admitted
49
What may you consider given if recurrent/ multi-trigger
Preventor | ICS or LTRA
50
What should you encourage parents to do
Stop smoking
51
SE of SABA
Tachy Tremor Flushing Headache
52
Lifestyle advice
``` Asthma action plan Vaccination Advise on triggers Weight loss and smoking cessation Inhaler technique and peak flow ```
53
WIW
More likely develop asthma

Paediatrics (35 decks)

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