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Year 3 > Case 2 - Asthma > Flashcards

Case 2 - Asthma Flashcards

1
Q

What are the 3 most important questions to ask at an asthma annual review?

A

Have you had difficultly sleeping due to your asthma?
Have you had your usual asthma symptoms during the day?
Has your asthma interfered with your usual daily activities?

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2
Q

What features indicate an acute severe asthma attack?

A

PEF 33-50% best or predicted
Respiratory rate: >25 min
Heart rate > 110/min
Inability to complete sentences in one breath

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3
Q

What features indicate a life threatening asthma attack?

A 
PEF <33% best of predicted 
SpO2 <92%
PaO2 <8kPa
Silent Chet 
Poor respiratory effort 
Arrthythmia 
Exhaustion / Altered conscious level 
Hypotension
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4
Q

What is difference in FEV1/FVC ratios for obstructive and restrictive lung disease?

A

Obstructive - ratio less than 0.7

Restrictive - ratio is either normal or high

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5
Q

What is the difference between obstructive and restrictive lung disease?

A

Obstructive - narrowing of the airways, so exhaled air comes out more slowly. Less time to breathe out all the air before next inhalation
Restrictive - lungs are damaged and stiff so cannot fully expand. Less air can enter and exit

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6
Q

What conditions can cause restrictive lung disease?

A 
Interstitial lung disease / pulmonary fibrosis 
Sarcoidosis 
Obesity 
Scoliosis 
Muscular dystrophy
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7
Q

What is the treatment for an acute asthma attack?

A 
Oxygen - aim for 94-98% sats
Oral or IV Steroids 
Beta agonist (salbutamol) nebulised
Ibatropium bromide nebulised 
Magnum sulphate - where PEF <50% and no response to bronchodilator therapy
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8
Q

Which drugs are contraindicated in patients with asthma?

A

NSAIDS
Beta blockers
Adenosine

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9
Q

What is the stepwise management of asthma in children (aged 5-16)?

A

1) SABA
2) SABA + low dose ICS
3) SABA + low dose ICS + leukotriene receptor antagonist
4) SABA + low dose ICS + LABA
5) SABA + maintenance reliever therapy (MART) includes low does ICS
6) SABA + moderate dose ICS MART
7) ICS high dose MART or trial additional drug e.g, theophylline, also refer to asthma specialist

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10
Q

What is the stepwise management of asthma in children (under the age of 5)?

A

1) SABA
2) SABA + 8 week trial of moderate dose ICS
3) SABA + low dose ICS + leukotriene receptor antagonist
4) Refer to paediatric asthma specialist

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11
Q

What is a maintenance and reliever therapy (MART)for asthma?

A

A form of combined ICS and LABA treatment in a single inhaler, used for both daily maintenance therapy and the relief of symptoms as required

MART is only available in which the LABA has a fast acting component (e.g, formoterol)

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12
Q

What are the low, moderate and high dose ICS dosages for children?

A

Low dose: <200 micrograms budesonide or equivalent
Moderate dose: 200-400 micrograms budesonide or equivalent
High dose: >400 micrograms budesonide or equivalent

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13
Q

What is the FeNO test for asthma?

A

Fractional exhaled nitric oxide

Levels of NO rise in response to inflammation which can occur in asthma

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14
Q

How is asthma diagnosed in adults?

A 
Spirometry - FVC1/FVC ratio less than 70%
Bronchodilator reversibility (BDR) - improvement of FEV1 by 12%
FeNO test
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15
Q

What is the stepwise treatment of asthma in adults?

A

1) SABA
2) SABA + low dose ICS
3) SABA + low dose ICS + leukotriene receptor antagonist (LTRA)
4) SABA + low dose ICS + LABA, continue LTRA depending on patients response
5) SABA +/- LTRA, switch ICS for maintenance reliever therapy (MART) includes low does ICS
6) SABA+/- LTRA, medium dose ICS MART
7) SABA+/- lTRA, high dose MART or additional drug e.g, theophylline, refer to asthma specialist

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16
Q

What are the low, moderate and high dose ICS dosages for adults?

A

Low dose: <400 micrograms budesonide or equivalent
Moderate dose: 400-800 micrograms budesonide or equivalent
High dose: >800 micrograms budesonide or equivalent

17
Q

How would you treat a patient that was having a severe asthma attack?

A

100% oxygen
Nebulised salbutamol and ipratropium bromide nebulisers
IV hydrocortisone

If no improvement then add IV magnesium sulphate
If no response then consider IV salbutamol

18
Q

When would you admit someone to hospital if they were having a moderate acute asthma exacerbation?

A

If they had worsening symptoms

If they have had a previous near fatal asthma attack

19
Q

What are the causes for a complete white out of a hemithorax on a chest X-ray?

A

Trachea central - consolidation, pulmonary oedema, pleural mass (mesothelioma)
Trachea pulled toward opacified side - pneumonectomy, total lung collapse
Trachea pushed away from opacified side - pleural effusion, diaphragmatic hernia, large pulmonary mass

20
Q

What is the difference between a primary and secondary pneumothorax?

A

Primary - no underlying lung disease

Secondary - underlying lung disease

Year 3 (24 decks)

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