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Flashcards in Asthma and COPD Deck (35):
1

Asthma triggers?

infections, allergens, occupational exposures, food additives and chemicals, irritants, aspirin and strong emotions

2

What lymphocyte is the inflammatory reaction in asthma led by?

Th2 lymphocytic response

3

Investigations for Asthma

  • Spirometry and reversibility
  • NO test -> rarely used
  • Blood test -> eosinophil
  • Histamine challenge
  • Skin prick/IgE CXR -> mostly to exclude and is usually clear.

4

Criteria to determine if a person has a high probability of asthma

  1. recurrent episodes
  2. symptom variability
  3. absence of symptoms of alternative diagnosis
  4. observed wheeze
  5. atopy
  6. PEF/FEV1

5

How to diagnose Asthma using peak flow?

record peak flow qds for 2-4 wks

6

Mild PEF reading?

>80% of best/predicted

7

Moderate PEF reading?

50-80% of best/predicted

8

Acute Severe PEF reading?

33-50% best/predicted

9

Life threatening PEF reading?

<33% best/predicted

10

What would be considered as a positive result for asthma when doing a bronchodilator reversibility test?

an increase in FEV1 of 12% (or more) and an increase in volume of 200 ml (or more)

11

example of inhaled steroid?

beclamethasone

12

example of oral steroid?

prednisolone

13

example of muscarinic antagonist?

ipatropium

14

example of leukotriene receptor antagonist and what type of asthma is it used to treat?

montelukast and allergy induced asthma

15

Is magnesium used more for asthma or COPD?

COPD

16

Criteria for well controlled asthma?

don't experience: daytime symptoms night time waking need for rescue meds asthma attacks limited activity abnormal lung fn minimal side effects

17

Treatment pathway for asthma

1. SABA 2. ICS 3. LABA 4. stop LABA and increase ICS 5. consider increasing ICS + alternative treatment + specialist care 6. Oral steroid

18

Management of acute asthma attack?

Oxygen 5mg salbutamol in nebuliser or 50 spacer puffs Prednisolone 40-50mg for 5 days Admit severe asthma

19

When should respiratory specialist follow up patients who've had a severe asthma attack?

at least 12 months after admission

20

When should primary care be informed of asthma attack?

within 24 hours of the attack

21

Features of a moderate asthma attack

increasing symptoms PEF >50-75% no signs of severe asthma

22

Features of a severe asthma attack

any one of: PEF 33-50% RR >25 HR >110 can't complete sentence in one breath

23

Features of a life threatening asthma attack

features of severe asthma plus any one of the following: PEF <33% SpO2 <92% silent chest cyanosis poor respiratory effort arrhythmia exhaustion low GCS hypotension

24

Features of near fatal asthma attack

raised PaCO2 and or requiring mechanical ventilation

25

Things you want to rule out when suspecting COPD

Lung cancer, PE and asthma

26

Investigations for COPD

- FBC (eosinophilia and anaemia)

- CXR (hyperinflation, bullae and flattened diaphragms)

- spirometry with reversibility

- BMI

- ABGs

27

What is the only intervention proven to have a prognostic effect on COPD?

STOP SMOKING

28

Treatment of patient with stable COPD 

stop smoking, vaccines, exercise

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29

Management of COPD Exacerbations

Increase frequency of SABA

Antibiotics (Amoxicillin 500mg tds)

Offer prednisolone 30mg

(some patients given rescue packs)

30

Stage 1 (Mild) COPD FEV1

>80%

31

Stage 2 COPD (Moderate) FEV1

50-79%

32

Stage 3 (Severe) COPD FEV1

30-49%

33

Stage 4 (very severe) COPD FEV1

<30%

34

learn COPD management

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