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WEEK 16:
ASTHMA PLENARY - INTEGRATED!!
| Question | Answer |
|---|---|
| respiratory causes of SOB | upper airway (croup) large airway/ medium sized airways (asthma) alveoli (emphysema and pneumonia) pleural problem (pleuritic chest pain) chest wall problem (trauma) respiratory/ cardiac interaction (pulmonary embolism) |
| cardiac causes of SOB | cardiac failure including: 1. heart muscle problem 2. heart valve problem 3. heart rhythm problem 4. obstructive heart problem |
| causes of SOB apart from cardiac and respiratory | Metabolic e.g. Diabetic ketoacidosis Haematological e.g. anaemia Neuromuscular Psychological e.g. anxiety Physiological e.g. pregnancy Drugs e.g. aspirin overdose |
| questions for HPC includes | What does she mean by short of breath or breathless? When did it start? How often does it happen? When does it happen? Any triggers? Any relieving factors? Any diurnal variation? Any associated symptoms? Does it restrict activity? |
| questions for PMH | Significant previous or ongoing conditions Atopic history –eczema, hayfever etc Immunisation history drug history family history |
| diagnostic tests/ examinations include | CXR oxygen saturations PEF BDR FeNO FBC |
| in a PEF what do you want to know | 1. the absolute value 2. Variability of readings:- A value of more than 20% variability after monitoring at least twice daily for 2 weeks is regarded as a positive result (NICE) |
| when is PEF result regarded as positive according to NICE | value of more than 20% variability after monitoring at least twice daily for 2 weeks |
| FEV1 is dependent on | gender and age |
| FVC is dependent on | gender and age |
| normal FEV1:FVC ratio | 0.75-0.85 |
| <70% indicates | airflow limitation |
| positive result of asthma using salbutamol in BDR requires | in adults and children aged 5-16, improvement in FEV1 of 12% or more with an increase of at least 200ml (in response to beta 2 agonists) |
| FeNO positive result includes | (fractional exhaled nitric oxide testing) level of >50ppb is considered a positive result indicating eosinophilic airway inflammation |
| what would FBC show | if eosinophil count is above lab reference |
| asthma definition | chronic respiratory condition associated with airway inflammation and hyper-responsiveness. Is reversible and obstructive |
| signs pointing to asthma | atopic history exercise induced allergen induced raised eosinophil count variability of symptoms reduced FEV1: FVC on spirometry reduced PEF family history test improvement with salbutamol |
| formoterol | LABA acting on Beta 2 receptor in smooth muscle of bronchi causing bronchodilation |
| ICS | eg beclomethasone and budesonide - cause anti-inflammatory action via cellular binding and modulating gene expression |
| MART needs | 1 ICS with 1 LABA eg budesonide and fometerol (1 puff in the morning and 1 puff in the evening to relieve symptoms but can take 6 puffs in an emergency but max 8-12 a day) |
| how many puffs to relieve symptoms | 1 in morning and evening |
| how many puffs in emergency | 6 |
| how many puffs max a day | 8-12 |
| severity of asthma is ranked in categories including (4) | near fatal, life threatening, severe, and moderate |
| what does the GP need to do after discharge | review how patient is check concordance with treatment check inhaler technique consider if preventer treatment needs increasing or additional treatments need adding ensure patient has WRITTEN asthma plan |
Created by:
kablooey
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