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Y1 - Respiratory > Asthma > Flashcards

Asthma Flashcards

(57 cards)

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1
Q

What is asthma?

A

A chronic inflammatory disease of the large and small airways

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2
Q

What are the three main factors in asthma?

A

Reversible airflow obstruction
Airway inflammation
Airway hyper-responsiveness

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3
Q

What happens in airway remodelling?

A

Basement membrane thickens
Submucosa undergoes collagen deposition
Smooth muscle hypertrophy

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4
Q

What is the most important type of cell that is involved in asthma?

A

Eosinophils

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5
Q

Asthma is Th1 mediated, true or false?

A

False - Th2

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6
Q

What cells cause inflammation in asthma?

A

Mast cells
Eosinophils
Dendritic cells
Lymphocytes

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7
Q

What are some triggers of asthma?

A 
Allergens (animals, dust, pollens, fungi)
Exercise
Viral infection
Smoke
Chemicals
Drugs (NSAIDs, beta blockers)
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8
Q

What is the PEFR for moderate, severe and life-threatening asthma?

A

Moderate: 75-50%
Severe: 50-33%
Life-threatening: <33%

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9
Q

What are risk factors for asthma?

A

Family history of asthma or eczema
Exposure to allergens (dust lites, pets, tobacco smoke)
Recent upper respiratory tract infection
Workplace sensitisers

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10
Q

What are the symptoms of asthma?

A 
Episodic attacks of breathlessness
Non-productive cough (can be nocturnal)
Chest tightness
Wheeze
Can be precipitated by triggers
Worse at night and early morning
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11
Q

What are the signs of asthma?

A

Poor air entry
Expiratory wheeze
Nasal polyposis

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12
Q

What are investigations for asthma?

A 
PEFR
FEV1/FVC ratio
ABGs
Bloods - high eosinophils
Trial salbutamol
Challenge test - provocation testing for bronchospasm (exercise, histamine, methacholine, mannitol)
Immunoassay for specific IgE
Skin prick test
Fractional exhaled nitric oxide
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13
Q

What do the following investigations show in asthma?
FEV1/FVC ratio
PEFR

A

FEV1/FVC ratio: <80% of predicted
PEFR decreased compared to normal for height and sex
Diurnal variability - lower in morning than afternoon

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14
Q

What are the common examples of ICS used for asthma maintenance?

A

Beclometasone
Butesonide
Fluticasone

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15
Q

What are some side affects of ICS?

A

Oral candidiasis
Stunted growth in children
Dysphonia (hoarse and weak voice)

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16
Q

What are the common examples of SABAs used for asthma relief?

A

Salbutamol

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17
Q

What is a side effect of SABAs?

A

Fine tremor
Tachycardia
Cardiac dysrhythmia
Hypokalaemia

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18
Q

What are the common examples of LABA used for asthma maintenance?

A

Salmeterol

Formoterol

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19
Q

What is the common LTRA?

A

Montelukast

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20
Q

What is an acute exacerbation of asthma?

A

An acute or subacute episode of progressive worsening of asthma symptoms

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21
Q

What are some triggers of an acute asthma attack?

A

Respiratory viruses
Allergen
Irritant

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22
Q

What are risk factors for an acute asthma attack?

A 
Previous near-fatal asthma - requiring ventilation or respiratory acidosis
Previous admission for asthma
Requiring 3 or more classes of asthma medication
Heavy use of SABA
Inadequate use of ICS
Incorrect inhaler technique
Smoker
Poor air quality
GORD
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23
Q

What are the symptoms of an acute asthma attack?

Study These Flashcards
A 
History of asthma
Bouts of dyspnoea and chest discomfort
Nocturnal cough
Wheeze
Clear sputum if any and no haemoptysis
24
Q

What are the signs of an acute asthma attack?

Study These Flashcards
A

Short of breath at rest
Tachypnoea
Tachycardia
Diminished breath sounds

25
What investigations are done for an acute asthma attack?
Pulse oximetry Peak flow ABGs ECG and CXR to exclude
26
What are the next treatments for an acute asthma attack after initial treatment?
Continue O2 at lower dose Oral steroids Nebulised salbutamol Monitor peak flow and oxygen saturations
27
What does airway hyper-responsiveness mean?
The airway becomes twitchy and sensitive to stimuli that are breathed in Can be either allergic or non-allergic
28
What causes the brief symptoms in asthma?
Bronchoconstriction
29
What does chronic airway inflammation cause in asthma?
Exacerbations | Airway hyper-responsiveness
30
What does airway remodelling lead to?
Fixed airway obstruction - irreversible
31
What are the clinical features of allergic asthma?
Childhood onset | Atopic triad: asthma, eczema, rhinitis
32
What are the specific treatments for allergic asthma?
Montelukast Antihistamines Allergen avoidance Omalizumab (monoclonal antibody to IgE)
33
What are the clinical features of eosinophilic asthma?
``` Eosinophils >0.15 4+ exacerbations in the previous year Usually adult onset F>M More steroid resistant ```
34
What is the specific treatment for eosinophilic asthma?
Prednisolone Mepolizumab or benralizumab (anti-Il-5) Anti-allergen not effective
35
What investigations are done in all suspected asthma?
Spirometry - FEV1/FVC, PEFR | Trial salbutamol
36
What investigations can be done if intermediate suspicion of asthma?
``` Spirometry Bronchodilator reversibility PEF charting Challenge tests FeNO Blood eosinophils Skin prick test IgE ```
37
What is the treatment for asthma?
1. Low dose ICS + SABA as required 2. ICS + LABA + SABA as required 3. if no response to LABA - stop LABA, increase ICS. If inadequate response to LABA - continue LABA, increase ICS. Consider trial of LRTA, theophylline, LAMA 4. Increase ICS to high dose. Consider addition of 4th drug. Refer to specialist care
38
Can SABAs be given on their own?
No - always ICS
39
When should you move to the next step in asthma management?
If needing to use SABA 3x week or more
40
When should you consider decreasing maintenance therapy?
If controlled with current medication for at least 3 months | Only consider stopping ICS completely for people using low dose ICS alone and are symptom free
41
When should you refer someone with asthma to secondary care?
Diagnosis unclear Suspected occupational asthma (symptoms better when not at work, adult onset, high risk occupations) Severe/life threatening asthma attack Red flags
42
What features in 'asthma' are red flags?
Prominent systemic features (myalgia, fever, weight loss) Unexpected clinical findings (crackles, clubbing, cyanosis, cardiac disease, monophonic wheeze or stridor) Persistent non-variable breathlessness Chronic sputum production Unexplained restrictive spirometry CXR shadowing Marked blood eosinophilia
43
What is the action of ICS?
Anti-inflammatory Decrease immunological response No bronchodilator effect
44
What is the action of SABAs in asthma?
Airway smooth muscle relaxation Increase mucus clearance Decrease mediator release from mast cells and monocytes
45
When is montelukast useful?
Allergic phenotypes | Exercise induced asthma
46
What are the side effects of montelukast?
Nightmares
47
What is he action of montelukast?
Bronchodilator Smooth muscle relaxation Decrease in mucus secretion and oedema
48
What is the example of LAMAs used most commonly in asthma?
Tiotropium
49
When is tiotropium useful in asthma?
To reduce exacerbations in severe patients | Breathless patients without allergy or inflammation
50
What is the action of theophylline?
Unclear Relaxation of smooth muscle Anti-inflammatory
51
What are the downsides of theophylline?
Doesn't work in smokers | Side effect: nausea
52
When is theophylline used?
If nothing else works
53
What is a moderate severity asthma attack?
Increasing symptoms PEF >50-75% No features of severe
54
What is a severe asthma attack?
``` Any one of: PEF 33-50% Resp rate >25 Heart rate >110 Inability to complete sentences in one breath ```
55
What is a life-threatening asthma attack?
``` Any one of: Altered conscious level Exhaustion Arrhythmia Hypotension Cyanosis Silent chest Poor respiratory effort PEF <33% SpO2 <92 PaO2 <8 'Normal' PaCO2 ```
56
What is the treatment for an acute asthma attack?
Oxygen - high dose by mask, maintain 94-98% sats Salbutamol nebuliser with O2 Ipratropium bromide nebuliser Steroids - increase ICS Single dose magnesium sulphate for severe or poor response to salbutamol
57
Which signs in an asthma attack require referral to intensive care?
Deteriorating PEF Persisting or worsening hypoxia Hypercapnia ABGs showing decreased pH or increased H+ Exhaustion, feeble respiration Drowsiness, confusion, altered conscious state Respiratory arrest

Y1 - Respiratory (12 decks)

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