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Respiratory System > Asthma Clinical Features in Adults > Flashcards

Asthma Clinical Features in Adults Flashcards

1
Q

What is asthma?

A

A disease characterised by an increased responsiveness of the trachea and bronchi to various stimuli and manifested by a widespread narrowing of airways that change in severity either spontaeously or a result of therapy

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2
Q

What is an important indicator of asthma, in terms of symptoms?

A

Variability of symptoms

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3
Q

What does asthma result in?

A

Widespread narrowing of the airways

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4
Q

What percentage of children have asthma?

A

10-15%

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5
Q

What percentage of adults have asthma?

A

5-10%

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6
Q

Are most children with asthma male or female?

A

Male

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7
Q

Are most adults with asthma male or female?

A

Female

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8
Q

How many people in the UK are recieving asthma treatment?

A

5.4 million

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9
Q

How many children in the UK are recieving asthma treatment?

A

1.1 million

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10
Q

How many adults in the UK are recieving asthma treatment?

A

4.3 million

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11
Q

How often does somebody have a life threatening asthma attack?

A

Every 10 seconds

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12
Q

What kinds of everyday things are totally or very limited by asthma?

A

Running

Sport

Stairs

Pets

DIY

Gardening

Pub

Waling

Sleeping

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13
Q

How many admissions of asthma are there a year?

A

67,000

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14
Q

How many bed days per year does asthma use?

A

220,000

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15
Q

How many GP consulations are about asthma?

A

4.1 million

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16
Q

What is the total cost of asthma to the NHS?

A

£889 million

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17
Q

What is the total cost of asthma to the economy, due to productivity and benefits?

A

£1460 million

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18
Q

What is the total cost of asthma to the economy and the NHS?

A

£2.349 billion

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19
Q

How many working days a year are lost due to asthma?

A

12.7 million days

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20
Q

How has asthma prevalence changes over the last 60 years?

A

Increased massively until about 2010 when it began to drop

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21
Q

What are some proven risk factors for asthma?

A

Genetics

Occupation

Smoking

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22
Q

What is atopy?

A

Inherited tendency to IgE response to allergens

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23
Q

If your mother has asthma how much more at risk are you than if your father had it?

A

3x

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24
Q

How much of adult onset asthma is due to occupation?

A

Underestimated at 10-15%

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25
Q

What kinds of things are people exposed to at work that leads to asthma?

A

Isocyanates (paint)

Colophony (welding)

Laboratory animals

Grains

Enzymes

Drugs

Crustaceans (shell fish)

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26
Q

What effect does maternal smoking during pregnancy have on the babies breathing?

A

Decreases FEV1

Increases wheezy illness

Increases airway responsiveness

Increases asthma

Increases severity

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27
Q

What is the ‘grandmother effect’?

A

If your grandmother smoked you are more at risk of asthma

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28
Q

What are some possible risk factors of asthma?

A

Obesity

Diet

Reduced exposure to microbes

Indoor pollution (chemical household products)

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29
Q

What kind of things in someones diet increases the risk of asthma?

A

Less antioxidants

Less n-3 polyunsaturated fatty acids

More n-6 polyunsaturated fatty acids

More and less vitamin D

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30
Q

Why do we know reduced exposure to microbes might increase the risk of asthma?

A

Children born on farms are less likely to develop asthma

31
Q

How do we know indoor pollution might increase the risk of asthma?

A

Cleaners are more at risk of developing asthma

32
Q

What are some environmental allergens linked to asthma?

A

House dust mite

Cat

Grass pollen

33
Q

What is it important to remember about the link between allergens and asthma?

A

Exposure to allergens does not cause atopy or asthma, but factors associated with affluence increase the likelihood of sensitisation to local allergens

34
Q

What are some things that might cause localised airway obstruction?

A

Inspiratory stridor

Tumour

Forign body

35
Q

What are some things that might cause generalised airway obstruction?

A

Asthma

COPD

Bronchiectasis

Bronchiolitis

Cystic fibrosis

36
Q

What is most important for making the asthma diagnosis?

A

History, examination is rarely useful

37
Q

What are some symptoms of asthma?

A

Wheeze

Short of breath

Chest tightness (pain)

Cough, usually dry

Sputum (occasionally)

38
Q

What does an asthma sufferer bringing up green spit mean?

A

Not always an infection, neutrophils and polymorphs from inflammation also cause this

39
Q

What are some different things that could trigger asthma?

A

Exercise

Cold air

Smoke

Perfume

Pets

Trees

Grass pollen

Food

Asparin

40
Q

When may symptoms vary?

A

At different times, there could be:

Daily variations (nocturnal/morning)

Weekly variations (occupation, better at weekends)

Annual variations (environmental allergens)

41
Q

What does asthma often show during an examination?

A

Breathless on exersion

Hyperexpanded chest

Polyphronic wheeze

42
Q

What if seen on examination suggests it is not asthma?

A

Clubbing, cervical lymphadenopathy

Stridor

Asymmetrical expansion

Dull percussion note (lobar collapse, effusion)

Crepitation (bronchiectasis, CF, alveolitis, LVF)

43
Q

What is crepitation?

A

A crackling sound

44
Q

What does it mean if the examination is normal?

A

It fits with asthma

45
Q

What does it mean if the examination is abnormal?

A

It does not fit with asthma

46
Q

What are we looking for in investigations to prove it is asthma?

A

Airway obstruction

Variability and/or reversibility of airway obstruction

47
Q

What is the first investigation we do for asthma?

A

FEV1 testing (spirometry)

48
Q

What do we do if spirometry testing for FEV1 is normal?

A

Test variability of airflow obstruction using a peak flow meter and chart twice daily for two weeks

Variability suggests asthma

49
Q

If the FEV1 testing is normal, how often and for how long is a peak flow meter used to test variability of airflow obstruction?

A

Twice daily for 2 weeks

50
Q

What do we do if the spirometry testing FEV1 shows obstruction?

A

1) Full pulmonary testing
2) Reversibility to bronchodilator
3) Reversibility to corticosteroids

51
Q

What does full pulmonary testing exclude?

A

COPD/emphysema

Increase gas transfer suggests asthma, decreased suggests COPD

52
Q

When does full pulmonary testing suggest asthma?

A

If increase gas transfer

53
Q

What is the process of testing reversibility to bronchodilator?

A

1) Take baseline measurement
2) Give salbutamol
3) Compare the difference

54
Q

When does testing the reversibility to bronchodilator suggest asthma?

A

Increase in FEV1 after salbutamol suggests asthma, no increase suggests COPD

55
Q

How much of an increase suggests asthma when testing reversibility to bronchodilator?

A

More than 12%

56
Q

When testing reversibility to oral corticosteroids, what suggests asthma?

A

Improvement suggests reversibility so asthma, no improvement suggests COPD

57
Q

What is the FEV1/FVC ratio for an airway obstruction?

A

Less than 70%

58
Q

What might suggest occupational asthma?

A

Suspicion from work related symptoms

Working with recognised occupational sensitiser

59
Q

How is occupational asthma confirmed?

A

Serial peak flow readings, 2 hourly best for 2 days minimum

Difference in and out of work shows occupational asthma

60
Q

What are examples of specialised investigations?

A

Airway responsiveness to methacholine/histamine

Exhaled nitric oxide

61
Q

What are some additional useful investigations?

A

Chest x-ray

Skin prick testing

Total and specific IgE

Full blood count

62
Q

What could a chest x-ray of someone with asthma show?

A

Hyperinflated, hyperlucent

No effusion, collapse, opacities, interstitial changes

63
Q

What does skin prick testing, total and specific IgE and full blood count test?

A

Atopic status

64
Q

Why is being objective more important than subjective?

A

Life threatening asthma may not induce any visible distress

65
Q

What physiological indicators are checked when dealing with asthma?

A

Ability to speak

Heart rate

Respiratory rate

PEF

Oxygen saturation/arterial blood gases

66
Q

What is acute asthma?

A

Flare up of asthma

67
Q

What are the different kinds of acute asthma?

A

Mild

Severe

Life threatening

Near fatal

68
Q

What are the physiological values for mild asthma?

A

Able to speak, complete sentances

Heart rare < 110

RR < 25

PEF 50-75%

SaO2 > 92%

PaO2 > 8kPa

69
Q

What are the physiological values for severe asthma?

A

Unable to speak, unable to complete sentences

HR > 110

RR >25

PEF 33-50%

SaO2 > 92%

PaO2 > 8kPa

70
Q

What are the physiological values for life threatening asthma?

A

Grunting

Impaired consciousness, exhaustion

HR > 130 or bradycardiac

Hypoventilating

PEF < 33%

Cyanosis

SaO2 < 92%

PaO2 < 8kPa

PaCO2 normal (4.6 - 6kPa)

71
Q

What physiological value is for near fatal asthma?

A

Raised PaCO2

72
Q

What does near fatal asthma require?

A

Mechanical ventilation

73
Q

What is bradycardia?

A

Slower heartrate than normal

74
Q

What is cyanosis?

A

Discolourisation to the skin

Respiratory System (37 decks)

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