Flashcards in Asthma Deck (16)
What is asthma?
Chronic inflammatory disease of the airways
What can trigger asthma?
What is the pathophysiology of asthma?
Hypersensitivity inflammatory reaction
Charactersied by the T-helper 2 response, eosinophils, and mast cells
Cells release histamine, prostaglandins and leukotrienes
Increased number of goblet cells
Smooth muscle hyperplasia
What is involved the T-helper 2 response?
IL 4 - promotes differentiation of T cells
IL 5 - promotes production of B cells
IL13 - promotes goblet cells, hyperplasia, hypertrophy and mucus secretion
TNF-a - acute phase protein
Leukotriene LTB4 - triggers contraction in airways
Mast cell tryptase - found in allergic response
What occurs in baseline asthma?
Thickening of basement membrane
Hypertrophy of airway muscle
What happens in acute asthma?
Excessive mucus production
What are the symptoms of asthma?
What are signs of asthma?
What investigations should be done for acute asthma?
What is the spirometry pattern in asthma?
Can be reversed with bronchodilators
How is baseline asthma classified?
- symptoms <2 week
- brief attacks
- FEV1 > 80 predicted
- symptoms >2 week, <1 day
- attacks effect activity
- FEV1 >80
- daily symptoms
- affect activity
- FEV1 60-80
- continuous symptoms
- limited physical activity
- FEV1 <60
How is acute asthma classifed?
- PEFR 50-75%
- PEFR 33-50%
- RR >25
- HR >110
- inability to complete sentences in one breath
- PEFR <33%
- SpO2 <92%
- PaO2 <8
- poor respiratory effort
- normal PaCO2
- Raised PaCO2
How is baseline asthma managed?
Step 1 = SABA
Step 2 = SABA + low dose inhaled corticosteroid
Step 3 = LABA + ICS
Step 4 = increase ICS dose OR add LTRA
Step 5 = add oral prednisolone
How is acute asthma managed?
OH SHIT MAN
Oxygen titrated to 94-98%
Ipratropium bromide nebs
Magnesium sulphate IV
What are the criteria for safe discharge?
5 days abnormal prednisolone
Asthma nurse to assess inhaler technique
GP follow up within 2 days
Respiratory clinic follow up within 4 weeks