FN: Chronic Asthma Flashcards Preview

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Flashcards in FN: Chronic Asthma Deck (27):
1

Definition

Episodic, reversible airway obstruction due to bronchial hyper-reactivity to a variety of stimuli

2

Epi

incidence 5-8%
Peaks at 5 yrs, most outgrow by adolesence

3

Acute pathophysiology

1. Mast cell-Ag interaction --> histamine release
2 Bronchoconstriction, mucus plugs, muscosal swelling

4

Chronic pathophysiology

1. Th2 release IL-3,4,5 --> mast cell, eosinophil and B cell recruitment
2. Airway remodelling

5

Causes

Atopy
Stress
Toxins

6

Atopy

T1 hypersensitivity to a variety of antigens
Dust mites, pollen, food, animals, fungus

7

stress

cold air
Viral URTI
Excercise
Emotion

8

Toxins

Smoking, pollution, factory
Drugs: NSAIDS, Beta-blockers

9

Symptoms

Cough ± sputum (often at night)
Wheeze
Dyspnoea
Diurnal variation with morning dipping

10

History

Precipitants
Diurnal variation
Excercise tolerance
Life effects: sleep, work
Other atopy: hay fever, eczema
Home and job environment

11

Signs

1. Tachypnoea, tachycardia
2. Widespread polyphonic wheeze
3. Hyperinflated chest
4. reduced air entry
5. Signs of steroid use

12

Associated Disease

1. GORD
2. Churg-stauss
3. ABPA

13

Differential

1. Pulmonary oedema (cardiac asthma)
2. COPD

14

Investigations

Bloods
CXR
Spirometry
PEFR monitoring/diary
Atopy

15

Bloods show

FBC - eosinophilia
raised IgE
Aspergillus serology

16

CXR shows

Hyperinflation

17

Spirometry

Obstructive pattern with FEV1:FVC 15% improvement in FEV1 with Beta agonist

18

PEFR monitoring.diary

Diurnal variation >20%
Morning dipping

19

Atopy

Skin-prick
RAST

20

General MEasures:TAME

Technique for inhaler use
Avoidance: allergens, smoking, dust
Monitor: Peak flow diary (2-4 x/d)
Educate

21

Education

Liaise with specialist nurse
Need for treatment compliance
Emergency action plan

22

Drug ladder

1. SABA PRN
2. Low-dose inhaled steroid: beclometasone
3. LABA: salmeterol 50 ugbd + steroid _ Leukotriene
4. Trials of increased inhaled steroids, Leukotriene receptor antagonist, SR theophylline, MR agonist PO
5. Oral steroids

23

Step 1

SABA but if using>1/d or nocte symptoms move to step 2

24

Step 2

Low-dose inhaled steroid: beclometasone 100-400ug bd

25

Step 3

LABA: salmeterol 50ug bd
1. Good response continue
2. Benefit but control still poor: increase steriod to 400ug bd
3. No benefit: discontinue + raise steroid to 400ug bd

If control is still poor consider trial of:
a. Leukotriene receptor antagonist (e.g. montelukast) - especially if excercise/NSAID-induced asthma
b. SR theophylline

26

Step 4

Trials of:
1. increased inhaled steroid to up to 1000ug bd
2. Leukotriend receptor antagonist
3. SR theophylline
4. MR beta agonist PO

27

Step 5

Oral steroids e.g. prednisolone 5-10mg od
1. Use lowest dose necessary for symptom control
2. Maintain high-dose inhaled steroid
3. Refer to asthma clinic

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