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Respiratory > Asthma > Flashcards

Asthma Flashcards

1
Q

What types of hypersensitivity reaction lead to asthma?

A

Type 1 (atopic) and 3 (occupational)

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2
Q

Define asthma

A

Reversible obstruction caused by airway hyperresponsiveness (muscle hypertrophy) leading to V/Q mismatch with bronchial inflammation and oedema (T cells, mast cells, excess mucus)

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3
Q

What airway remodelling occurs in asthma?

A

Squamous replaced with coloumnar and goblet cell metaplasia

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4
Q

What questions need to be asked in asthma history?

A

Nocturnal waking
Diurnal variation
ADL interference
Provoking features

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5
Q

How is asthma managed?

A 
SABA
SABA and ICS
SABA and ICS and LABA
SABA and ICS and LTRA/Theophylline
Oral Steroid

Under 5s no LABA- LTRA step 3 then escalalte

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6
Q

How is an moderate exacerbation managed

A

Salbutamol neb
Ipatropium bromide neb
IV hydrocortisone or oral pred for 5 days
Antibiotics for infection is present

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7
Q

What constitutes well controlled asthma?

A

No daytime symptoms.
No night-time waking due to asthma.
No need for rescue medication.
No asthma attacks.
No limitations on activity including exercise.
Normal lung function (FEV1 and/or PEF > 80% predicted or best).

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8
Q

What is a validated asthma questionnaires for assessing baseline?

A

Asthma control questionnaire

Also spirometry

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9
Q

After adjusting treatment when should you assess impact?

A

4-8 weeks after

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10
Q

When should you prescribe ICS?

A

Use an inhaled SABA three times a week or more, and/or
Have asthma symptoms three times a week or more, and/or
Are woken at night by asthma symptoms once weekly or more.

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11
Q

How does smoking affect ICS?

A

Increased dose needed

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12
Q

How many times a day should ICS be used?

A

Twice

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13
Q

How often must asthma patients be reviewed?

A

Annually
Peak flow/ spirometry checked
Flu jab

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14
Q

What must be recorded in an asthma review?

A

Number of asthma attacks, oral corticosteroid use, time off school/nursery/work due to asthma.
Nocturnal symptoms
Adherence (which can be assessed by reviewing prescription refill frequency).
Possession of/use of a self-management plan/written personalised asthma action plan.
Exposure to tobacco smoke.

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15
Q

What are the RCP 3 questions for adults iwth asthma?

A

Have you had difficulty sleeping because of your asthma symptoms (including cough)?
Have you had your usual asthma symptoms during the day (e.g. cough, wheeze, chest tightness, or breathlessness)?
Has your asthma interfered with your usual activities (e.g. housework, work, school)?

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16
Q

What should those on long term steroids be offered monitoring of?

A

Blood pressure.
Urine or blood sugar (measured by HbA1c).
Cholesterol.
Bone mineral density.
Vision (to assess for cataracts and glaucoma).

17
Q

What is heard in stethoscope with asthma?

A

Bilateral widespread polyphonic wheeze

18
Q

What diagnostic tests are done in asthma?

A

Fractional exhaled NO
Spirometry with bronchodilator reversibility
If uncertainty:
Peak flow variability (diary over 2-4 weeks)
Direct bronchial challenge with histamine

19
Q

What’s the issue with Theophylline?

A

Narrow therapeutic window- needs monitoring with plasma levels

20
Q

What constitutes a moderate exacerbation of asthma?

A

PEFR 50-75% predicted

21
Q

What constitutes a severe exacerbation of asthma?

A 
PEFR <33%
Sats <92%
Tired
No wheeze
Shock
22
Q

What should be done in severe exacerbation?

A

O2 to jeep sats above 94%
Aminophylline infusion
Consider IV salbuatmol
IV MgSO4 if life threatening and ICU

23
Q

What does an ABG in ashta show?

A 
Resp alkalosis initially as tachypnoea causes drop in Co2
Then acidosis (BAD)
24
Q

What are side effects of salbuatmol/

A

K+ absorbtion into cells

Tachycardia

25
Q

What do patients need to be discharged with?

A

Asthma action plan

Rescue pack of medds

Respiratory (13 decks)

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