Y4 - CCC & PC > Asthma > Flashcards

Asthma Flashcards

(50 cards)

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1
Q

What is the defintion of asthma?

A

a chronic respiratory condition characterised by hyper-responsive airways which become narrow due to inflammation and tightening of the smooth muscles

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2
Q

What is the prevalence of asthma?

In which group is there a higher incidence?

A
  • 8 million people in the UK with a diagnosis
  • 5.4 million are receiving treatment
  • there is a higher incidence in children
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3
Q

What is the most common industrial lung disease?

A

occupational asthma

accounts for 15% of adult-onset asthma

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4
Q

What is the basic aetiology of asthma?

A
  • an allergen enters the airway and triggers an allergic response
  • this involves inflammation mediated by mast cells, IgE and eosinophils
  • the inflammatory cascade damages the epithelium of the airway, allowing more allergens to enter
  • this results in airway hyperresponsiveness, smooth muscle hypertrophy and mucus plugging
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5
Q

What type of airway obstruction is present in asthma?

A

reversible airway obstruction

the obstruction only happens in response to a trigger

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6
Q

What are the known associations for triggering onset of asthma?

A
  • personal or FH of atopic disease
  • social deprivation
  • tobacco smoke exposure
  • obesity
  • pollution
  • premature birth / low birth weight
  • respiratory infections in infancy
  • workplace exposures
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7
Q

What is meant by the atopic triad?

A

asthma, allergic rhinitis & eczema

there is a tendancy for these 3 conditions to occur together

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8
Q

How does someone with asthma typically present to the GP?

A

with a history of shortness of breath, dry cough and chest tightness

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9
Q

When taking an asthma history, what questions are important to ask relating to their symptoms?

A
  • “are symptoms always present?” - there must be variability in symptoms
  • “do you wake up at night breathless?” - there must be diurnal variation
  • “are there noises present when you breathe?”
  • “are there any triggers?” - could be dust, pets, smoking or exercise
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10
Q

What other areas are important to cover when taking an asthma history?

A

Establishing RFs
* FHx of asthma
* FHx or personal Hx of atopy / food allergies
* GORD can make asthma worse

Previous asthma care
* has patient ever been hospitalised, had IV steroids or intubation?

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11
Q

What are the 4 main clinical features of asthma?

What is the pattern of symptoms like?

A
  • cough
  • polyphonic wheeze
  • chest tightness
  • shortness of breath

symptoms are EPISODIC with a DIURNAL VARIATION and occur in response to TRIGGERS

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12
Q

What clinical signs might be present in an asthma patient?

A
  • expiratory polyphonic wheeze
  • nasal polyps
  • work of breathing
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13
Q

How is asthma diagnosed?

A

there is no single diagnostic test for asthma

diagnosis involves clinical judgement and supportive tests

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14
Q

What 4 tests may be performed as part of the diagnosis of asthma?

A
  • FeNO
  • spirometry
  • peak flow
  • bronchodilator reversibility testing
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15
Q

What is involved in the FeNO test?

A
  • FeNO = fractional exhaled nitric oxide
  • it measures the levels of nitric oxide when breathing out
  • NO is produced when the airways are inflamed
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16
Q

What FeNO readings would be expected in asthma?

A

FeNO is increased in asthma

  • > /= 40ppb in adults > 17
  • > / = 35 ppb in children aged 5-16
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17
Q

What 4 things are measured in spirometry?

A
  • forced vital capacity (FVC)
  • forced expiratory volume (FEV1)
  • FEV1 : FVC
  • bronchodilator reversibility
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18
Q

What is forced vital capacity (FVC)?

A

the total amount of air that can be forcibly blown out in one breath

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19
Q

What is forced expiratory volume (FEV1)?

How is this changed in asthma?

A

the volume of air that can be forcibly blown out in one second

this is REDUCED in asthma

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20
Q

What is the FEV1 / FVC?

How is this changed in asthma?

A

this is the percentage of air blown out in the first second

this should be < 0.7 in asthma

this is because FEV1 decreases with little change in FVC

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21
Q

What is bronchodilator reversibility?

What reading would be expected in asthma?

Study These Flashcards
A

this determines whether lung function improves with medication

there should be a >12% and 200ml increase in FEV1 post SABA

22
Q

Typically, what would a normal spirometry graph look like?

Study These Flashcards
A
  • in healthy lungs, most of the breath is blown out within the first second
23
Q

What would an obstructive pattern look like on spirometry?

Study These Flashcards
A
  • this is typical of an obstructive lung condition, such as COPD and asthma
  • the air flows out of the lungs more slowly than it should (low FEV1)
  • less than 70% of the total amount is blown out in the first second
24
Q

What would a restrictive pattern look like on spirometry?

Study These Flashcards
A
  • the total amount of air that you can breathe in is reduced
  • the speed that you can breathe out is preserved
  • both the FEV1 and FVC will be lower than predicted, but the ratio between the 2 will not be reduced
25
How is bronchodilator reversibility testing performed?
* **400 micrograms** of **salbutamol** is administered and spirometry is repeated after **15 mins**
26
What do the results of bronchodilator reversibility show?
* reversibility is present if **spirometry improves** * the **presence of reversibility** suggests a diagnosis of **asthma** * the absence of reversibility suggests a fixed respiratory pathology (e.g. COPD) * partial reversibility suggests a mixed picture
27
How is peak flow measured?
it measures **how fast a patient can breathe out** after a **full breath in** the score is always **lower** if the airways are **inflamed**
28
When is peak flow used in clinical practice?
* can be used to **diagnose** asthma, monitor the **response to treatment** or monitor **recovery after an attac**k * in diagnosis, a patient is asked to keep a **peak flow diary** * this should show **> 20% variability** over **2-4 weeks**
29
What are the main aims of asthma management?
30
Before pharmacological treatment, what are the fundamentals of managing asthma?
* ensure correct diagnosis * **avoid triggers** * **smoking cessation** * adherence to all medications and ensuring **correct technique** is used
31
What are the 2 different groups of medication someone with newly diagnosed asthma is given?
**Preventer medication:** * these are inhaled corticosteroids that ***reduce airway inflammation*** **Reliever medication:** * these cause ***smooth muscle relaxation*** to open the airways to **relieve the symptoms**
32
What is the main preventer medication used?
***low dose inhaled corticosteroids*** (e.g. beclomethasone) these are taken daily to **prevent asthma symptoms** and **attacks** | thiis is the most effective treatment when taken correctly
33
What is the main reliever medication used? How long does this last for?
***short-acting beta-2 agonists*** (e.g. salbutamol) this has a **rapid onset** of action and lasts for **4 hours** this is only for ***symptom relief*** and is not effective in exacerbations | increased use can predict exacerbations
34
What additional medications may be added on to asthma treatment?
other more intense **reliever** medications to **reduce symptoms** and open the airways * *leukotriene receptor antagonists* (LRTA) * *long-acting beta-2 agonists* (LABA) * *long acting muscarinic antagonist* (LAMA)
35
What is an example of a LABA? How do these work and when should they be used?
***salmeterol*** * they act on beta-2 receptors to cause **smooth muscle relaxation** * they have a **12 hour** duration of action * should only be used alongside **regular ICS**
36
How is it decided at what level to initiate medical treatment? How is control maintained and response to treatment measured?
* treatment initiated at a level appropriate to the **severity** of the patient's asthma * control maintained by **increasing treatment as necessary** * the response to treatment should be reviewed **4 to 8 weeks** after **any medication change**
37
What is meant by MART?
***maintenance and reliever therapy*** combination inhaler with a **steroid** and fast-acting **LABA**
38
What is involved in the stepwise management of asthma in adults?
39
How often should treatment be reviewed? What should be done if the treatment is not working?
every **4 to 8 weeks** * if treatment does not work, assess **adherence** and whether it is being **taken correctly** * if satisfied, then stop this treatment
40
How often should patients with asthma be reviewed? Which groups may be reviewed more regularly?
* patients with asthma should be reviewed **at least annually** * some groups are reviewed more often: ***poor lung function*** ***severe asthma*** history of ***asthma attack in last year*** increased risk of ***poor outcomes***
41
What are the important areas to cover in an asthma review?
42
What are the expected outcomes from an asthma review?
* adjustment of treatment * review asthma management plan * education and support
43
What is particularly important to assess during an asthma review?
***inhaler technique*** * patient may also have **spacers** to improve lung deposition of the drug | ask patient to demonstrate how they use their inhaler
44
What is meant by an acute exacerbation of asthma? How can it be categorised?
the onset of **severe asthma symptoms** * severity can be characterised as **moderate**, **severe** or **life-threatening**
45
What is meant by a moderate asthma attack?
PEFR will be **50-75%** of best/predicted
46
What is meant by a severe asthma attack? How might someone present?
* PEFR is ***33-50%*** of best/predicted * RR >/= **25 per min** * pulse rate >/= **110 bbpm** * often **unable to complete sentences** and use of **accessory muscles**
47
What is meant by a life-threatening asthma attack? How might someone present?
* PEFR is ***< 33%*** of best/predicted * O2 sats **< 92%** * patient is exhausted and may be **confused** * there is poor respiratory effort with **cyanosis** or **silent chest** * there may be cardiac **arrhythmia** or **haemodynamic instability**
48
When is hospital admission required for an acute exacerbation?
* hospital admission is needed for **severe or life-threatening** asthma that **does not adequately respond to initial treatment**
49
What is the management for acute exacerbations of asthma?
* increased doses of **ICS** * **SABA** * short course of **oral prednisolone**
50
When should a patient be followed up following an acute exacerbation of asthma?
* if admitted to hospital, they should be followed up within **2 days of discharge** * if not admitted, they should be followed up within **48 hours of presentation**
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