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Medicine > Case 2 - Asthma - Progress Test Revision > Flashcards

Case 2 - Asthma - Progress Test Revision Flashcards

1
Q

What type of reaction is asthma?

A

Type 1 hypersensitivity

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2
Q

What immune cell is over active in asthma?

A

IgE

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3
Q

Risk factors for asthma

A 
Personal / family history of atopy. 
Antenatal factors: maternal smoking, viral infection during preganacy (especially RSV). 
Low birth weight. 
Not being breastfed. 
Maternal smoking around child. 
Exposure to high concentrations of allergens. 
Air pollution. 
Hygiene hypothesis.
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4
Q

Related IgE conditions

A 
Atopic dermatitis (eczema). 
Allergic rhinitis (hay fever)
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5
Q

What medication are some patients with asthma sensitive to?

A

Aspirin

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6
Q

What are some examples of occupational triggers for asthma?

A

Isocyanates (eg. spray painting, foam moulding using adhesives)
Flour

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7
Q

What time of day is an asthmatic cough often worst?

A

Night

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8
Q

What are the signs of asthma

A

Expiratory wheeze on auscultation.

Reduced PEFR.

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9
Q

Spirometry results in asthma

A 
FEV1  = significantly reduced 
FVC = normal 
FEV1/FVC = < 70%
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10
Q

What other tests can be used to diagnose asthma?

A

Fractional exhaled nitric oxide

shows level of inflammation

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11
Q

What is the 1st line medication for asthma?

A

SABA (eg. salbutamol)

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12
Q

What are side effects of a SABA?

A

Tremor

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13
Q

2nd line medication for asthma?

A

SABA + ICS (eg. beclamethasone, dipropionate, fluticason, propionate)

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14
Q

What are side effects of ICS?

A

Oral candidiasis

Stunted growth in children

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15
Q

4th line medication for asthma?

A

SABA + ICS + LABA (eg. salmeterol) +/- LTRA

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16
Q

3rd line medication for asthma?

A

SABA + ICS + Leukotriene receptor antagonist (eg. monteleukast) PO

17
Q

What medications are in a MART inhaler?

A

ICS + LABA

18
Q

5th line medication for asthma

A

SABA +/- LTRA + MART

19
Q

What is a positive FeNO result for asthma?

A

> 40 parts per billion

20
Q

What is a postive spirometry result for asthma?

A

< 70%

obstructive

21
Q

What is a positive reversibility testing result for asthma?

A

Improvement in FEV1 of >= 12%
+
Increase in volume of >= 200ml

22
Q

What is classified as moderate acute asthma?

A

PEFR 50-75% best or predicted

Speech normal

RR < 25 / min

Pulse < 110 bpm

23
Q

What is classified as severe acute asthma?

A

PEFR 33-50% best or predicted

Can’t complete sentences

RR > 25 / min

Pulse > 110 bpm

24
Q

What is classified as life-threatening asthma?

A

PEFR < 33% best or predicted

O2 sats < 92%

Normal pCO2 (exhaustion)

Silent chest, cyanosis or feeble respiratory effort

Bradycardia, dysrhythmia or hypotension

Exhaustion, confusion or coma

25
Q

Who should be admitted to hospital in acute asthma?

A

All patients with life-threatening asthma

Patients with severe asthma who don’t respond to initial treatment

Patients with a previous near fatal attack

Pregnant patients

An attack in patients on oral corticosteroids

Patients presenting at night

26
Q

What is the management of acute asthma?

A

O2 - 15L non-rebreathe

SABA (eg. salbutamol / terbutaline)

Oral prednisolone 40-50mg - for at least 5 days or until recovered

Ipratropium bromide

IV magnesium sulphate

IV aminophylline (requires senior consultation)

Referal to ITU/HDU for intubation and ventilation / ECMO

27
Q

What is the criteria for discharge after acute asthma?

A

Stable on discharge medication for 12 - 24 hrs

Inhaler technique checked and recorded

PEF > 75% best or predicted

28
Q

What are the stages of asthma pathogenesis?

A
  • Sensitisation
  • Early phase reaction
  • Late phase reaction
29
Q

What happens during the sensitisation stage of asthma pathogenesis?

A
  • Exposure to inhaled allergen.
  • Stimulates induction of Th2 cells.
  • Th2 cells secrete cytokines and stimulate B cells to produce IgE.
  • The cytokines induce IL-4 (which increases IgE production), IL-5 (which activates eosinophils) and IL-3 (which activates mucus secretion).
  • IgE coats mast cells and repeated allergen exposure triggers mast cells to release granule contents and produce cytokines
30
Q

What is involved in the early phase reaction of asthma?

A
  • Bronchoconstriction.
  • Increased mucus production.
  • Variable degrees of vasodilation with increased vascular permeability.
31
Q

What is involved in the late phase reaction in asthma

A
  • Inflammation.
  • Chemokine release from mast cells, epithelial cells and T cells.
  • Recruitment of leucocytes (especially eosinophils, neutrophils and T cells).
32
Q

What enzyme does aspirin block, causing it to be a trigger in asthma?

A

Cyclo-oxygenase

reducing production of prostaglandins

33
Q

What is the pharmacology of SABA / LABA

A

Agonists of B2 adenoceptors on bronchiole smooth muscle - causing relaxation

34
Q

What is the pharmacology of theophylline?

A
  • Phosphodiesterase (PDE) inhibitor (triggers activation of PKA and muscle relaxation).
  • Adenosine receptor antagonist.
35
Q

What is the pharmacology of ipratropium?

A
  • Muscarinic receptor antagonist.

muscarinic receptors are triggered in asthma by binding of ACh, causing smooth muscle contraction

36
Q

What is the pharmacology of monteleukast?

A
  • Leukotriene receptor antagonist.
  • Prevents activation of the leukotriene receptor (which causes broncoconstriction) and promotes production of prostaglandins (which cause bronchodilation).
  • Act at cysteinyl-leukotriene receptors on bronchiole smooth muscle cells preventing action of LTC4 and LTD4 (which cause bronchial spasm and stimulate mucus secretion)
37
Q

What is the pharmacology of glucocorticoids?

A

Reduce production of cytokines, spasmogens (LTC4 and LTD4) and leucocyte chemotaxins (LTB4, PAF).

  • Hence reduced bronchospasm and recruitment and activation of inflammatory cells
38
Q

What receptors do glucocorticoids bind to?

A

GR alpha and GR beta

Causing induction of lipocortin and repression of IL-3

Medicine (15 decks)

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