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YR6: RESPIRATORY > Asthma > Flashcards

Asthma Flashcards

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1
Q

Define Asthma and describe what it is characterised by

A

chronic inflammatory disorder of the airways
Reversible bronchospasm resulting in airway obstruction

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2
Q

List 5 behavioural/ familial risk factors of asthma

A

Personal/ FH of atopy
Antenatal: maternal smoking, infection (esp. RSV)
LBW
Not being breastfed
Maternal smoking around child

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3
Q

List 3 environmental risk factors for asthma

A

Exposure to high conc. allergens e.g. House dust mites
Air pollution
Hygeine hypothesis

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4
Q

What do atopic patients with asthma also suffer from?

A

Other IgE mediated atopic conditions:
Atopic dermatitis (Eczema)
Allergic rhinitis (Hay fever)

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5
Q

What drug are a number of patients with asthma sensitive to?

A

Aspirin

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6
Q

What percentage of adult asthma is occupational asthma? How is this identified?

A

10-15% related to allergens in workplace e.g. isocyanates + flour
Reduced peak flows during working week + normal readings when not at work

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7
Q

List 3 presenting symptoms of asthma

A

Cough (often worse at night)
Dyspnoea
“Wheeze”, “Chest tightness”

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8
Q

Give 2 signs of asthma

A

Expiratory wheeze on auscultation
Reduced peak expiratory flow rate (PEFR)

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9
Q

What spirometry results are seen in asthma?

A

FEV1: significantly reduced
FVC: normal
FEV1/FVC <70%

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10
Q

Which patients with suspected asthma should have objective diagnostic testing?

A

All >5 years

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11
Q

What investigations should adults with suspected asthma have?

A

Spirometry with bronchodilator reversibility test (BDR)
FeNO test

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12
Q

If asthma symptoms are better when away from work, how should the patient be investigated?

A

Serial measurements of PEFR at work + away from work
Refer to specialist as possible occupational asthma

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13
Q

What investigations should children with suspected asthma have?

A
  1. Spirometry with bronchodilator reversibility test (BDR)
  2. FeNO if normal or obstructive spirometry with -ve BDR
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14
Q

What does FeNO testing show?

A

Levels of inducible nitric oxide rise in inflammatory cells (esp. eosinophils) + correlate with levels of inflammation

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15
Q

What FeNO results are considered positive in adults and children?

A

Adults >40 parts per billion
Children >35 parts per billion

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16
Q

What is considered as positive in reversibility testing for asthma in adults and children?

A

Adults: improvement in FEV1 by >,12% + increase in volume of >,200ml
Children: improvement in FEV1 by >,12%

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17
Q

Asthma may be diagnosed in adults meeting any of which 5 criteria?

A
  1. FeNO >,40 ppb
  2. Post-bronchodilator improvement in lung volume of 200 ml
  3. Post-bronchodilator improvement in FEV1 of >,12%
  4. PEFR variability of >,20%
  5. FEV1/FVC ratio <70%
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18
Q

Describe the stepwise management of asthma in adults

A
  1. SABA + Low dose ICS
  2. SABA + Low dose ICS + LTRA
  3. SABA + Low dose ICS + LABA +/- LTRA
  4. SABA +/- LTRA
    Switch ICS/ LABA to MART (inc low dose ICS)
  5. SABA +/- LTRA + medium dose ICS MART
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19
Q

What is an alternative to medium dose ICS MART?

A

Changing back to a fixed dose of a moderate ICS + separate LABA

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20
Q

What management is required for patients with asthma not responding to SABA, LTRA and medium dose ICS MART?

A

Refer to specialist
Increase ICS to high dose (as fixed dose regime, not MART)
Trial additional drug e.g. long acting muscarinic receptor antagonist or Theophylline

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21
Q

What constitutes a low, medium and high dose ICS using budesonide or equivalent?

A

Low: <400 micrograms
Med: 400-800 micrograms
High: >800 micrograms

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22
Q

How often should step down of asthma treatment be considered in stable patients? How would this be done?

Study These Flashcards
A

Every 3 months
Reduce ICS by 25-50% at a time

23
Q

What is the most common chemical cause of occupational asthma?

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A

Isocyanates e.g. spray paint + foam moulding using adhesives

24
Q

4 signs of moderate acute asthma exacerbation

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A

PEFR 50-75% best/ predicted
Speech normal
RR <25/ min
HR <110 bpm

25
4 signs of severe acute asthma exacerbation
PEFR 33-50% best/ predicted Can't complete sentences RR >25/min HR >110 bpm
26
6 signs of life-threatening acute asthma exacerbation
PEFR <33% best/ predicted O2 sats <92% Normal pCO2 indicates exhaustion Silent chest, cyanosis, or feeble respiratory effort Bradycardia, dysrhythmia or hypotension Exhaustion, confusion or coma
27
What characterises near-fatal asthma exacerbation?
Raised pCO2 +/or requiring mechanical ventilation with raised inflation pressures
28
When is an ABG indicated in asthma exacerbations?
O2 sats <92%
29
When is a CXR indicated in acute asthma exacerbations?
Life-threatening asthma Suspected pneumothorax Failure to respond to Tx
30
What are 6 indications for admission of an acute asthma exacerbation?
If life-threatening If severe + fail to respond to initial Tx If previous near-fatal attack If pregnant If attack occurring despite spreading using oral CS If present at night
31
Which patients should be started on supplemental O2 in acute asthma?
If hypoxaemic If acutely unwell
32
What oxygen therapy should be commenced in an acutely unwell patient?
15L via non-rebreathe mask Titrated down to a flow rate where they can maintain 94-98%
33
Describe management of patients with mild-moderate acute exacerbation of asthma
Salbutamol via pressurised MDI, 2-10 puffs every 10-20 mins 40-50mg Prednisolone PO daily for at least 5 days +/- O2
34
Describe management of patients with severe acute exacerbation of asthma
Salbutamol 5mg via oxygen driven nebuliser over 20-30 mins + Ipratropium nebs 500 micrograms every 4-6h + Prednisolone 40-50mg PO
35
What can be given if severe acute asthma exacerbation is not responsive to initial treatment?
Discuss with senior IV Magnesium Sulfate
36
Describe management of patients with life-threatening acute exacerbation of asthma
Salbutamol 5mg via oxygen driven nebuliser over 20-30 mins + Ipratropium nebs 500 micrograms every 4-6h + Prednisolone 40-50mg PO or Hydrocortisone IV
37
What can be given if life-threatening asthma exacerbation is not responsive to initial treatment?
Discuss with senior IV Magnesium Sulfate IV Aminophylline Mechanical ventilation
38
What is the criteria for discharge following admission for acute exacerbation of asthma?
Stable on discharge meds (no O2 or news) for 12-24h Inhaler technique checked + recorded PEF >75% of best or predicted
39
Describe inhaler technique for metered dose inhalers
1. Remove cap + shake 2. Breathe out gently 3. Put mouthpiece in mouth + as you begin to breathe in, which should be slow + deep, press canister down + continue to inhale steadily + deeply 4. Hold breath for 10s, or as long as is comfortable 5. For a 2nd dose wait for ~30s before repeating steps 1-4. Only use the device for the number of doses on the label, then start a new inhaler.
40
What are 5 precipitating factors of asthma?
``` Cold Viral infection Drugs (e.g. b-blockers, NSAIDs) Exercise Emotions ```
41
What should you ask about when taking history of possible asthma?
Previous hospitalisation due to acute attacks- indicates severity of asthma Hx of atopic disease: allergic rhinitis, urticaria, eczema
42
Why is a normal PCO2 is a BAD SIGN in a patient having an asthma attack?
Patient should be hyperventilating + blowing off their CO2, so PCO2 should be low A normal PCO2 suggests patient is fatiguing
43
Describe the stepwise management of chronic asthma | NICE guidelines
1. SABA (salbutamol) 2. SABA + ICS 3. SABA + ICS + LTRA 4. SABA + ICS + LTRA + LABA 4. a) + Increase ICS to mod-high dose 4. b) + slow-release theophylline or Long acting muscarinic receptor antagonist 5. + Oral steroids
44
Describe the prognosis of asthma
Many children improve when older | Adult onset is chronic.
45
What 3 physiological factors contribute causes difficulty breathing air out of the lungs?
Bronchoconstriction Airway wall thickening Increased mucus
46
Give an example of each drug used in asthma
``` SABA: Salbutamol ICS: Beclometasone, Budesonide LABA: Formoterol LTRA: Montelukast Oral steroid: Prednisolone ```
47
What is the MOA of SABAs?
Relax smooth muscle + dilates bronchioles "Reliever", "Blue inhaler"
48
Name 1 side effect of SABAs
Tremor
49
What is the MOA of ICS?
Suppress airway inflammation + reduce airway hyper-responsiveness Taken every day regardless of Sx "Preventer"
50
Name 2 side effects of ICS
Oral candidiasis Stunted growth in children
51
MOA of Ipratropium bromide
Short acting muscarinic antagonist
52
MOA of LABA and regime?
Relax airway smooth muscle Taken everyday regardless of Sx
53
Which long term asthma medication is taken orally?
Monteleukast (LTRA)
54
What measure can be used to assess control of asthma?
Asthma Control Test (ACT)

YR6: RESPIRATORY (38 decks)

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