Flashcards in Asthma Deck (11):
Chronic inflammatory disease of airways where many cells and play role, in particular mast, neutrophils, eosinophils, T cells, macrophages, epithelia.
Causes recurrent cough (especially at night), wheeze, SOB, chest tightness due to widespread variable reversible airflow obstruction.
Genetic predisposition likely.
Allergic/extrinsic triggered by exposures causing IgE response.
Non allergic intrinsic in response to infection or stress.
Occupational exposure or exercise or drug induced.
Inflammatory condition fo bronchial hyper responsiveness. Inflammation (thickening), bronchsopasm and excessive secretion.
Brochiectasis or bronchitis
Avoid triggers, stop smoking, hygiene eg dust.
SABA. Education on inhaler use.
Then add low dose inhaled CS eg beclomethasone if SABA used more than 3x a week or waking 1x a week. Steroid inhibits transcription in inflammatory cells and mediators, decrease eosinophils and mast, increase beta 2 R expression and anti inflammatory IL's.
Then go to medium dose ICS
Then go to LABA eg salemterol.
Then high dose ICS, can add eg leukotriene R antagonist.
Then oral CS eg prednisolone.
Beta agonist eg tachy, palpitation, tremor, anxiety, HYOKALAEMIA.
ICS eg croaky voice, sore throat, thrush.
Nocturnal cough- exercise induced in day, dry
Tachypnoea and tachycardia
Accessory muscles, tracheal tug, intercostal recession, nasal flaring.
Prolonged expiratory phase
Decreased air entry
Respiratory failure and arrest
Status asthmaticus not respond to immediate treatment.
Peak flow vs predicted, diary, diurnal variation
Spirometry obstructive pattern- FEV1/FVC under 70%
In the history
PNH- eczema, hayfever
FH- atopy, smoking
SH- mound, farm, wood burning fire, pets
DH- any drugs make it worse eg NSAIDs
Acute attack grading
Mild to moderate T1 respiratory failure
-mild- sats over 92, pulse under 110, RR under 25, speech fine, minimal wheeze, PEFR over 75% of predicted.
-moderate- same but more of a wheeze and PEFR 50-75% predicted.
-severe- sats under 92, pulse over 110, RR over 25, can complete sentence, no wheeze, PEFR 35-50%.
-life threatening- sats under 92 and cyanosis, silent chest, altered conciousness, exhaustion, PERF 35%.
-tx- SABA and ipratropium nebs, O2, IV access, ITU and intubation.