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Respiratory > Asthma > Flashcards

Asthma Flashcards

1
Q

Identify three risk factors of asthma

A
  • Personal or family history of atopic disease
  • Respiratory infections in infancy
  • Exposure to tobacco smoke
  • Premature birth and low birth weight
  • Obesity
  • Social deprivation
  • Workplace exposure (flour dust and isocyanates)
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2
Q

Identify three clinical features of asthma

A
  • Expiratory polyphonic wheeze
  • Dry cough
  • Dyspnoea
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3
Q

What is meant by diurnal symptoms?

A
  • Asthma symptoms are worse at night or early in the morning
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4
Q

What is the first line investigation in asthma?

A
  • Spirometry testing
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5
Q

Identify two findings on spirometry testing

A
  • FEV1/FVC less than 70%

- FEV1 less than 80%

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6
Q

What is a positive result with bronchodilator reversibility testing?

A
  • FEV1 improvement of 12% or more
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7
Q

When if FeNO testing carried out?

A
  • Where diagnosis is uncertain with spirometry
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8
Q

What is a positive result with FeNO testing?

A
  • FeNO level of 40 ppb in adults

- FeNO level of 35 ppb in children

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9
Q

When are variable PEF readings performed?

A
  • When diagnosis is uncertain with both spirometry and FeNO testing.
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10
Q

How should variable PEF readings be performed?

A
  • Twice daily

- For 2 - 4 weeks

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11
Q

What is a positive result with variable PEF readings?

A
  • Diurnal variation > 20%
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12
Q

When is direct bronchial challenge testing performed

A
  • When diagnosis is uncertain with spirometry, FeNO testing and variable PEF readings
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13
Q

Identify a positive result of direct bronchial challenge test

A
  • PC20 (provocative concentration causing 20% drop in FEV1) of 8 mg/ml or less
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14
Q

What is seen on FBC in asthma?

A
  • Raised eosinophils
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15
Q

What is seen on CXR in asthma?

A
  • Hyperinflation
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16
Q

Identify three differential diagnoses of asthma

A
  • Bronchiectasis
  • COPD
  • Cystic fibrosis
  • Foreign body aspiration
  • Heart failure
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17
Q

Identify a reliever therapy in asthma

A
  • Inhaled SABA
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18
Q

Identify two SABAs

A
  • Salbutamol

- Terbutaline

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19
Q

When is an inhaled corticosteroid prescribed

A
  • When SABA is used three times in a week or more
  • Asthma symptoms three times a week or more
  • Woken up at night by asthma symptoms once weekly
20
Q

Identify two inhaled corticosteroids

A
  • Beclometasone

- Budesonide

21
Q

When is a LTRA prescribed?

A
  • When symptoms are not controlled by an inhaled steroid
22
Q

Identify two LTRAs

A
  • Montelukast

- Zafirlukast

23
Q

When is a LABA prescribed?

A
  • When symptoms are not controlled by an inhaled steroid and LTRA
24
Q

Identify two LABAs

A
  • Salmeterol

- Formoterol

25
Q

What is maintenance and reliever therapy (MART)?

A
  • Single inhaler
  • Consisting of low dose ICS
  • And fast-acting LABA
26
Q

When is MART prescribed?

A
  • In patients whose symptoms are not controlled by an inhaled steroid and LTRA
27
Q

Identify two drugs that can be trialled if symptoms are not controlled by a moderate maintenance dose ICS (MART)

A
  • Muscarinic agent (ipratropium or tiotropium)

- Theophylline

28
Q

Identify a drug that is prescribed if all of the above measures fail to control symptoms

A
  • Oral steroids (prednisolone)
29
Q

Identify 3 causes of a severe asthma attack

A
  • Poor adherence
  • Respiratory virus infections
  • Exposure to allergen or triggering drug
30
Q

Identify 3 clinical features of acute severe asthma

A
  • Inability to complete a sentence in one breath
  • Tachypnoea
  • Tachycardia
31
Q

Identify 3 clinical features of a life threatening asthma attack

A
  • Silent chest
  • Cyanosis
  • Exhaustion
  • Confusion
  • Confusion
  • Coma
  • Bradycardia
  • Hypotension
32
Q

Identify four investigations for severe and life threatening asthma attacks

A
  • PEFR
  • Pulse oximetry
  • ABG
  • CXR
33
Q

What is the PEFR in life-threatening asthma?

A
  • <30%
34
Q

What are the oxygen saturations in life-threatening asthma?

A
  • <92%
35
Q

What is seen on ABG in life-threatening asthma?

A
  • PaCO2 > 6 kPa

- PaO2 < 8 kPa

36
Q

Identify three differential diagnoses of acute or severe life-threatening asthma ttack

A
  • Foreign body inhalation
  • Anaphylaxis
  • Pulmonary embolism
  • Pneumothorax
  • Acute exacerbation of COPD
37
Q

What is the first line management of a severe asthma attack?

A
  • Controlled supplementary oxygen 40 - 60 %

- To maintain an SpO2 94 - 98%

38
Q

What is the first medication given in acute asthma?

A
  • Nebulised salbutamol
39
Q

What medication is given if there is a poor response to nebulised salbutamol?

A
  • Nebulised ipratropium bromide
40
Q

What medication is given if there is a poor response to nebulised ipratropium bromide?

A
  • Intravenous hydrocortisone

OR

  • Oral prednisolone
41
Q

What medication is given if there is a poor response to steroids?

A
  • Intravenous magnesium sulfate
42
Q

When should patients be admitted to ICU?

A
  • Life-threatening asthma exacerbation

- Severe asthma exacerbation not controlled by the above measures

43
Q

Identify three adverse effects of SABAs

A
  • Tachycardia
  • Palpitations
  • Tremor
44
Q

Identify an adverse effects of inhaled steroids

A
  • Oral candida
  • Hoarse voice
  • Pneumonia in COPD
45
Q

Identify an adverse effect of LABAs that is not an adverse effect of SABAs

A
  • Muscle cramps
46
Q

Identify three adverse effects of LTRAs

A
  • Abdominal pain
  • Headache
  • Churg-Strauss syndrome
  • Hepatotoxicity
  • Agranulocytosis (Zafirlukast)

Respiratory (2 decks)

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