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Asthma pathophys
Asthma Pathophysiology
| Question | Answer |
|---|---|
| What percentage of Australians suffer from asthma? | Approximately 11% |
| What are the symptoms of asthma? | Wheeze, shortness of breath, chest tightness and cough |
| What are the 3 key characteristics of asthma? | 1. Airway inflammation and mucous hypersecretion 2. Airway hyperresponsiveness (triggers that release chemical mediators) 3. Airway remodelling (structural changes in the lungs) |
| What are the two types of asthma? How are they different | 1. Type 2 inflammation (which is eosinophilic, TH2 CD4+ T lymphocytes, IL-4,5,13, IgE 2. Non-Type 2, neutrophilic, TH1/17 CD4+ T lymphocytes, IFN, IL-17 |
| Name the key inflammatory mediators that localise in the lungs | Histamine, interluekins, prostaglandins, leukotrienes, nitrous oxide |
| What are the unavoidable asthma triggers? | Exercise, laughter, respiratory tract infections, some medicines, comorbidities, extreme emotions, hormone changes, pregnancy, sexual activity |
| What drugs can trigger asthma? | Aspirin, NSAIDS, beta blockers, royal jelly, echinacea, willow bark, anything with a salicylate or salicin, cholinergic agonists and anticholinesterases, prostaglandin analogues) |
| What are the co-morbidities that can impact asthma symptoms control? | Rhinitis (both types), gord, obesity, COPD, smoking, mental illness, hyperventilation, obstructive sleep apnoea, respiratory infections, |
| For patients that also have allergic rhinits, what product can they use to help control their asthma symptoms? | Intranasal corticosteroids if not using already |
| What are the symptoms of an acute asthma exacerbation 'attack'? | Sudden worsening of lung function, severe wheeze, non-stop coughing, very rapid breathing, chest tightness/pressure, difficulty talking, neck and chest muscles tightening, anxiety, panic, sweaty face, cyanosis, confusion, lethargy, unconsciousness |
| What are the factors associated with an increased risk of asthma deaths? | No asthma action plan, poor adherence with ICS meds, hx of near fatal asthma, hospital in last 12 months, over use of SABA's, using/recently stopped ICS, food allergies, pneumonia, diabetes, arrhythmias, psychiatric/psychosocial problems |
| What is the diagnosis of asthma in children based on? | History, physical examination, differential diagnosis, clinical response to a trial of SABA or preventer. |
| True or false: asthma shouldn't be diagnosed in children 12 months and under. | True. Wheezing at this age is commonly due to acute viral bronchitis, small or floppy airways. Refer to paediatric respiratory doctor if severe. |
| How is asthma diagnoses in children aged 1-5? | Step based approach. History and physical examination, trial of preventor/reliever, if responding to treatment then provisional diagnosis of asthma is made. This age is hard as respiratory symptoms can appear, but wheeze is common, spirometry not feasible |
| How is asthma diagnosed in children aged 6-11 years? | History, physical examination, spirometry test (FEV1 increase +12% from baseline), if spirometry can't be done then trial preventer/reliever. Children in this age group are likely to have asthma if they wheeze. |
| What factors make an asthma diagnosis more likely in children aged 6-11 years? | Recurrent/seasonal symptoms, symptoms worse at night, family history of atopy/asthma, rapid relief from quick acting bronchodilator, lung function testing suggests it, triggered by viral infections, exercise, cold air, damp air, emotions, laughing etc |
| How is asthma diagnosed in adults? | History, physical examinations, considering alternate diagnoses, documenting variable airflow limitation. There is no single reliable test or clinical diagnostic criteria. |
| In adults, what are the clinical features that increase probability of having asthma? | Wheeze, breathlessness, chest tightness, cough, history of atopy, family history of atopy, unexplained low FEV1, unexplained peripheral blood eisinophilia or raised IgE, relief from SABA, wheeze heard on auscultation of the chest |
| How are spirometry reversibility tests interpreted for an asthma diagnosis? | Increase in FEV1 of 200mL+ and 12%+ from baseline 10-15 mins after bronchodilator (adults) Increase in FEV1/FVC of 12% + (children) |
| How can peak flow testing be used in asthma management? | For those with eisinophilic or allergic asthma it can show levels of inflammation and how well ICS meds are controlling inflammation. |
Created by:
LDM
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