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Respiratory System > Asthma in Adults > Flashcards

Asthma in Adults Flashcards

(48 cards)

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1
Q

FEV1/FVC ratio?

A

Obstructive - so decrease

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2
Q

Pathology

A

Inflammatory condition characterised by bronchoconstriction by smooth muscle contraction and airway oedema (mucus)

Reversible

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3
Q

Aetiology

A

Passive smoking
Maternal smoking - lungs don’t develop
Air pollution
Occupation - jobs exposing to dust, vapours, fumes
Airway hyper responsiveness - Type 1 hypersensitivity

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4
Q

Symptoms

A 
SOB
Wheeze
Cough 
Chest tightness
Diurnal variability - timing 
Episodic 
Atopy
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5
Q

Signs

A 
Tachypnoea 
Wheeze 
Eczema
Response to bronchodilators 
Peak flow returns to normal (reversible)
Obstructed spirometry
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6
Q

Useful Investigations

A

CXR (hyperinflation, hyperlucent)
Skin prick test to measure serum IgE (assess atopy)
FBC (eosinophilia - atopy)
U+Es (renal function)

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7
Q

Aims of treatment

A 
No day/night symptoms 
No need for rescue meds
No asthma attack (Exacerbation) 
Normal lung function (no limitations)
FEV1 or PEF > 80% 
Minimal side effects
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8
Q

Non pharmacological management

A

Exercise
Smoking cessation
Weight management
Flu/pneumococcal vaccines

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9
Q

Pharmacological management

A 
Inhaled short acting B agonist - reliever 
Inhaled corticosteroid (ICS)
Inhaled LABA

Add on:
Leukotriene receptor antagonists
Theophyllines
Oral steroids

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10
Q

Benefits of inhalers

A 
Small dose 
Delivered straight to airways and lungs
Onset of effect faster 
Low systemic exposure
Side effects less severe and less frequent
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11
Q

When to escalate treatment

A

If there is no response to inhaled LABA - stop LABA and increase dose of ICF

If benefit from LABA but control by patient is inadequate - continue LABA and increase ICS to medium dose. If still inadequate then consider trial of other therapy

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12
Q

Acute asthma sign

A

Can they complete sentence before breathlessness?

Hunch forward and shoulders raised to increase vol. into lungs

Wheezy, cough

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13
Q

How to prevent acute asthma attack

A 
Patient specific 
Know trigger (patients know their action plan and their signs)
Avoid delays 
Follow guidelines
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14
Q

Asthma attack features

A

PEF 33-50% of normal
RR > 25
HH > 110
Cant finish sentence in one breath

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15
Q

What cause the narrowing of the airways?

A

Airway inflammation mediated by immune system cause bronchoconstriction, and releases ACh, histamine and leukotrienes from mast cells, eosinophils and macrophages and asthmatics usually have increased airway reactivity causing further narrowing

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16
Q

Risk factors

A

Genetic - atopy
Occupation
Smoking - decrease FEV1 and increase airway responsiveness

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17
Q

Describe the genetic factors in the risk of developing asthma

A

Genetic tendency for IgE to respond to allergens

Immune response genes: IL-4 / 5, IgE
Airway gene: ADAM33

3x more likely to develop if mother has atopy

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18
Q

What to look for in clinical history

A

PMH:
Childhood asthma, bronchitis
Hayfever

Drugs:
Current inhalers, check technique and compliance
B-blockers, aspirin, NSAIDs

FMH:
Atopic disease

PSH:
Smoking
Pets
Occupation

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19
Q

Interpretation of spirometry

A

FEV/FVC ratio <70%

FEV1 < 80% predicted

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20
Q

Use of PEF

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A

Lung function in clinic may be normal, PEF used to look for variability in airflow obstruction

Peak flow meter and chart, twice daily for 2 weeks

Look for:
Morning/nocturnal dips
Decline over weeks/days
Variability > 20%

Can diagnose occupation asthma (lowest PEF during weekdays)

21
Q

What are the main investigations?

Study These Flashcards
A

Spirometry
Pulmonary function test (to look for COPD)
Reversibility
PEF - if spirometry is normal

22
Q

Sign of life threatening acute severe asthma

Study These Flashcards
A 
Grunting 
Impaired consciousness, confusion, exhaustion
HR > 130 or bradycardic
Hypoventilating 
PEF < 33% best
Cyanosis

Sao2 < 92% (no ventilation)
PaO2 < 60mmHg
PaCO2 normal

23
Q

Sign of asthma attack (fatal)

24
Q

Step 1 in treatment

Study These Flashcards
A

Start on inhaled short acting B2 agonist - relievers

Salbutamol (MDI, DPI)
Terbutaline (DPI)

25
Step 2 in treatment of adults
Add low-dose ICS (200-800mg) - preventer
26
Step 3 (add on therapies) in treatment of adults
Add inhaled long acting B2 agonist to ICS
27
In step 3, what happens if there is no response to LABA?
Stop LABA and increase dose of ICS to 800mg
28
Step 4 of treatment in adults
Consider trials of: Increasing ICS to 2000mg Addition of fourth drug - LTRA, theophylline, beta agonist tablet, LAMA
29
Step 5 of treatment in adults
Use daily steroid TABLET Maintain high dose of ICS May refer patient to specialist
30
Three oral therapies
Leukotriene receptor antagonist Theophylline Prednisolone
31
Use of ICS criteria
If using inhaled B2 agonist > x3 a week Waking 1 night a week Sub-normal exercise tolerance
32
Specialist options for treatment
Omalizumab (anti-IgE) Mepolizumab (anti-interleukin-5) Bronchial thermoplasty
33
Response to mild/moderate acute asthma attack
``` Increase inhaler use Oral steroid Treat trigger Early follow up plan Back up plan ```
34
Response to sever acute asthma attack
``` HOSPITAL Nebulisers - salbutamol, ipratroprium Oral/IV steroid Magnesium (helps bronchoconstriction) Aminophylline Know triggers - infection/allergen Complication - do CXR ```
35
Benefit of inhalers over oral therapy
Direct delivery to target organ (airway and lungs) Onset of effect faster Minimal systemic exposure (adverse effect less)
36
What is a pMDI?
Metered dose inhalers: | Delivers specific dose of drug by aerosol
37
Advantages and disadvantages of pMDIs
Doesn't require deep breath (low inspiratory flow) | But requires coordination for simultaneous push and inspiration - no effective for young and elderly
38
What is a DPI?
Dry powder inhaler: Requires high inspiratory flow Less coordination required
39
What can occupation expose a person to which would increase risk of developing asthma?
Isocyanates (paint) Grains Enzymes Crustaceans
40
Describe the effect of maternal smoking during pregnancy in asthma
Nicotine causes modification in oocyte in female foetus' Decrease FEV1 Increase wheeze Increase airway response Increase asthma and severity
41
What is the 'grandmother' effect of asthma risk?
Mother smoked: 50% chance of developing Maternal grandmother smoked: 150% Mother and maternal smoked: increased further
42
What are conditions that cause general airflow obstruction?
``` Asthma (reversible AFO) COPD (irreversible AFO) Bronchiectasis Bronchiolitis CF ```
43
What is investigated in pulmonary lung function tests?
Lung volumes: Increase residual volume Increase total lung capacity RV/TLC > 3-% CO Gas Transfer
44
How do you intemperate reversibility to bronchodilator investigation?
Baseline and then 15mins post salbutamol Significant reversibility: FEV1 >200ml and FEV1 > 15% of baseline
45
What are the steps in investigations if spirometry is obstructed?
1. Spirometry = obstructed 2. Pulmonary function test 3. Reversibility to bronchodilators 4. Reversibility to corticosteroids
46
How is reversibility to corticosteroids investigation carried out?
0.6mg/kg Predinisolone for 2 weeks Peak flow chart and meter Baseline and 2 week spirometry
47
What are the steps in investigation if the spirometry is normal?
1. Spirometry = normal 2. Peak flow meter and chart, twice a day for 2 weeks 3. 'Optional' investigation for SPECIALIST - airway responsiveness to histamine/exercise and exhaled nitric oxide (FeNO)
48
What can a CXR show in asthma?
Hyperinflated Hyperlucent (No effusion, collapse, opacities, interstitial changes)

Respiratory System (29 decks)

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