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Year One - Respiratory System > Chronic Asthma > Flashcards

Chronic Asthma Flashcards

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1
Q

What is asthma?

A

It is a chronic inflammatory airway disease
leading to variable airway obstruction

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2
Q

What hypersensitivity reaction is associated with asthma?

A

Type 1

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3
Q

What is the pathophyiosology of asthma?

A

In asthma patients, the smooth muscle within the airways is hypersensitive, responding to stimuli by constricting and therefore causing airflow obstruction

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4
Q

What is the key characteristic feature of the bronchoconstrcition associated with asthma?

A

It is reversible

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5
Q

What are the nine risk factors of asthma?

A

Atopy Personal/Family History

Antenatal Factors

Low Birth Weight

Bottle Feeding

Obesity

Allergen Exposure

Air Pollution

Hygiene Hypothesis

Occupation

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6
Q

What is atopy?

A

It is defined as the body’s predisposition to develop an antibody called immunoglobulin E in response to environmental allergens

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7
Q

What is more influential - maternal or paternal atopy?

A

Maternal

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8
Q

What are the three main atopic conditions?

A

Asthma

Atopic dermatitis (eczema)

Allergic rhinitis (hayfever)

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9
Q

What two genes are associated with asthma?

A

ADAM33

ORMDL3

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10
Q

What two antenatal risk factors are associated with asthma?

A

Maternal Smoking

Viral Infection

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11
Q

What antenatal viral infection is most commonly associated with asthma?

A

RSV

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12
Q

What is the hygiene hypothesis?

A

It refers to reduced exposure to infectious agents in childhood resulting in abnormal development of the immune system - specifically resulting in a Th2 predominant response

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13
Q

What is the most common occupational risk factor of asthma?

A

Isocyanate exposure

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14
Q

What are the three clinical features of asthma?

A

Dry Cough

Dyspnoea

Bilateral Expiratory Wheeze

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15
Q

What are the two characteristics of the clinical features associated with asthma?

A

Episodic

Diurnal variability - worse in the early morning and night

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16
Q

What clincal feature indiciates a differential diagnosis to asthma?

A

Peripheral paraesthesia during dyspnoea episodes

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17
Q

List seven common triggers of asthma

A

Infection

Dust

Exercise

Animals

Smoking

Cold air

Food allergens

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18
Q

What three food allergens commonly trigger asthma?

A

Peanuts

Shellfish

Eggs

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19
Q

In most cases how is asthma diagnosed?

A

Clinically

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20
Q

What four investigations can be used to confirm a diagnosis of asthma?

A

Spirometry

Peak Flow Meter

Fractional Exhaled Nitric Oxide (FeNO)

Direct Bronchial Challenge Test

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21
Q

What two things need to be proven through investigations, in order to confirm a diagnosis of asthma?

A

Airflow obstruction

Airflow obstruction reversibility

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22
Q

What are the two first line investigations used to diagnose asthma?

A

Spirometry

FeNO

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23
Q

What is spirometry?

A

It is an investigation that measures the volume and flow of air during exhalation and inhalation

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24
Q

What three metrics are obtained from spirometry?

A

Forced Expiratory Volume 1 (FEV1)

Forced Vital Capacity (FVC)

FEV1 : FVC

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25
What is FEV1?
It is defined as the volume that has been exhaled at the end of the first second of forced expiration
26
What is FVC?
It is defined as the volume that has been exhaled after a maximal expiration, following a full inspiration
27
What four spirometry results indicate a diagnosis of asthma?
Reduced FEV1 Normal FVC FEV1 : FVC < 70% Increased TCLO
28
Following abnormal spirometry results, what should be tested?
We test the reversibility of airflow obstruction
29
In what two ways can we test reversibility of airflow obstruction with spirometry?
Bronchodilator response Corticosteroid response
30
Describe how bronchodilators can be used to test the reversibility of airflow obstruction in spirometry
We administer 400ug inhaled salbutamol or 2.5-5mg nebulised salbutamol We conduct spirometry tests 15 minutes following administration The results are deemed to demonstrate reversibility when FEV1 > 400ml or FEV1 of > 12%
31
Describe how corticosteroids can be used to test the reversibility of airflow obstruction in spirometry
We administer 30mg oral prednisolone for a period of 14 days or 500mcg inhaled beclomethasone for a period of 6 weeks The results are deemed to demonstrate reversibility when FEV1 > 400ml or FEV1 of > 12%
32
In cases where spirometry results are normal, however clinical suspicion remains high what is the most appropriate next step? Why?
FeNO This is due to the fact that normal spirometry doesn't exclude asthma as a diagnosis
33
What are peak flow meter tests?
They involve the patients blowing as hard and as fast as they can into a small handheld device This measures the rate at which air is exhaled from the lungs, obtaining a peak expiratory flow (PEF) score in litres of air breathed out per minute
34
How can peak flow meter tests be used to diagnose asthma?
We ask patients to conduct peak flow meter readings at home twice daily for a period of 2 – 4 weeks These readings are then plotted upon a chart, which incorporate the patient’s age, height and sex
35
What three peak flow meter test results indicate asthma?
Morning/nocturnal dips A gradual decline of results over A variability of results greater than 20% on more than 3 consecutive days of the week
36
What are FeNO tests?
They measure the level of nitric oxide in the exhaled breath, providing information about the eosinophilic inflammation in the lungs
37
How do FeNo test results provide information about eosinophilic inflammation in the lungs?
This is due to the fact that nitric oxide is produced by inducible nitric oxide synthase (iNOS), with levels increasing in inflammatory cells – particularly eosinophils Therefore, the level of nitric oxide correlated with the levels of inflammation.
38
What FeNO result indicates a diagnosis of asthma?
> 40 parts per billion
39
What is a direct bronchial challenge test?
It involves gradually increasing doses of medications that can irritate the airways to precipitate airway constriction It therefore measures hypersensitivity of the airways
40
What three medications can be used in direct bronchial challenge tests?
Histamine Methacholine Mannitol
41
What direct bronchial challenge results indicate a diagnosis of asthma?
There are reduced medication doses required to precipitate constriction
42
What are the seven pharmacological management options of asthma?
Short Acting Beta-2 Agonists (SABA) Inhaled Corticosteroids (ICS) Long Acting Beta-2 Agonists (LABA) Long Acting Muscarinic Agonists (LAMA) Leukotriene Receptor Antagonists (LTRA) Maintenance & Reliever Therapy (MART) Oral Theophylline
43
Name two SABA inhalers
Salbutamol Terbutaline
44
Salbutamol is what inhaler colour?
Blue
45
When are SABA inhalers used to treat asthma?
They are the first line pharmacological option
46
What is another term for SABA inhalers? Why?
Reliever inhalers They are used to relieve acute asthma features as required
47
What is the mechanism of action of SABA inhalers?
Adrenalin enables relaxation of the smooth muscle in the airways
48
What is the main side effect of SABA?
Tremor
49
Name three inhaled corticosteroid inhalers used to manage chronic asthma
Beclomethasone dipropionate Fluticasone propionate Budeonside
50
Beclomethasone dipropionate is what colour of inhaler?
Brown
51
Fluticasone propionate is what colour of inhaler?
Purple
52
When are ICS inhalers used to treat asthma?
They are the second line pharmacological option
53
What is another term for ICS inhalers? Why?
Preventor inhalers They should be administered by the patient every day regardless of whether the patient experiences asthma features
54
At what frequency should ICS inhalers be initially administered?
Twice daily
55
What are the two side effects of ICS inhalers?
Oral candidiasis Stunted growth
56
Name a LABA inhaler
Salmeterol
57
When are LABA inhalers used to treat asthma?
They are the third line pharmacological option
58
What is another term for LABA inhalers? Why?
Preventer inhalers They should be administered by the patient every day regardless of whether the patient experiences asthma features
59
What is the mechanism of action of LABA inhalers?
The adrenalin in these inhalers works to relax the smooth muscles within the airways
60
Name a LAMA
Tiotropium
61
When are LAMAs used to treat asthma?
They are the fourth line pharmacological options used to treat asthma
62
What is another term for LABA inhalers? Why?
Preventer inhalers They should be administered by the patient every day regardless of whether the patient experiences asthma features
63
What is the mechanism of action of LAMAs?
Acetylcholine receptors are stimulated by the parasympathetic nervous system and cause contraction of the bronchial smooth muscle LAMAs inhibit the acetylcholine receptors and therefore prevent its effects
64
Name an LTRA
Oral montelekast
65
When are LTRAs used to treat asthma?
They are the fourth line pharmacological option
66
What is the mechanism of action of LTRAs?
Leukotrienes are produced by the immune system to cause inflammation, bronchoconstriction and mucus secretion LTRAs inhibit leukotrienes and therefore prevent its effects
67
What is MART?
It is a form of combined inhaled corticosteroid and long acting beta-2 agonist treatment in a single inhaler
68
How do we administer MART?
It can be administered for both daily maintenance therapy and to relieve acute asthma features as required
69
When do we administer MART?
It is only recommended in individuals who have poorly controlled asthma
70
When is oral theophylline used to treat asthma?
It is a fourth line management option It should only be considered after trials of short/long acting bronchodilators or in those who are unable to administer inhaled therapy
71
What is the mechanism of action of oral theophylline?
It works by relaxing bronchial smooth muscle and reducing inflammation
72
Why does oral theophylline need to be closely monitored? How often do we conduct monitoring?
It has a narrow therapeutic window, therefore monitoring of plasma levels in the blood is required This monitoring is conducted 5 days after treatment is initiated and 3 days following dose changes
73
What are the six stepwise management options for asthma?
Short Acting Beta-2 Agonist (SABA) Inhaler As Required Add An Inhaled Corticosteroid (ICS) Add A Long Acting Beta-2 Agonist (LABA) Consider Trial of Oral LTRA, Oral Beta 2-Agonist, Oral Theophylline or LAMA Titrate Up The Inhaled Corticosteroid (ICS) Dose. Combine Additional Treatments From Step Four Specialist Referral
74
How do we determine the efficacy of asthma management?
It is based upon the patient’s clinical history, rather than a specific investigation For example, in patients who are requiring more than three doses of their SABA inhaler per week, we would recommend that their medication is reviewed accordingly
75
What complication occurs when patients have a poor inhaler technique?
Oral candidiasis
76
What is the diagnosis when individuals present with asthma, sinusitis, haematuria and eosinophilia?
Churg's stress syndrome

Year One - Respiratory System (14 decks)

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