CORE CONDITIONS
Rachel Farrelly [um18rf]
,1. RESPIRATORY CORE
CONDITIONS
,Disorder Acute Asthma
Definition An asthma exacerbation is an acute or subacute episode of progressive worsening of symptoms of
asthma, including shortness of breath, wheezing, cough, and chest tightness
How common is it Roughly 9% of people (5.4 million in UK)
160, 000 per annum incidence
Who does it affect 1 in 11 children – in early childhood it is higher in boys than girls in adulthood this is the other
way round
1 in 12 adults
What causes it Airway inflammation and yper-resoinsiveness – different underlying disease processes and
variations in severity, clinical course and response to treatment
Airway limitation is usually reversible, either spontaneously or with treatment
- Chronic asthma – may be irreversible as a result of wall remodelling and mucus impactation
Characterised into:
- Extrinsic: allergens can be identified by +ve skin-prick reactions to common inhaled allergens,
e.g. dust mite, pollen and fungi, in adults sensitisation to chemicals or biological products in
the workplace may be the cause
- Intrinsic: often starts in the middle age and no definite external cause can be identified, many
pts do show a degree of atopy and on close questioning give a hx of respiratory symptoms
consistent with childhood asthma
Risk Factors Personal or Fx of atopic disease – asthma, eczema, allergic rhinitis or allergic conjunctivitis
Respiratory infections in infancy
Exposure to tobacco smoke and inhaled particulates
Obesity
Social deprivation
Flour dust and isocyanates from paint
Symptoms/History Variable symptoms
Wheeze, cough, breathlessness and chest tightness
Symptoms are commonly diurnal (worse at night or early morning) and/or triggered or
exacerbated by exacerbated by exercise, viral infection and exposure to cold air or allergens
In children, it can also be triggered by emotion and laughter
In adults, it can be triggered by use of NSAIDs and B-blockers
Signs/Examination Symptomatic wheeze on auscultation
Differential Normal structures
diagnosis Skin infections
Benign tumours
Malignant primary tumours
Thyroid lumps
Salivary gland lumps
Congenital and developmental lumps carotid body tumours
Aneurysms
Trauma
Investigations 1st LINE:
e.g. to confirm - PEAK FLOW MEASUREMENT
diagnosis, exclude - O2 SATS – performed immediately
physical causes etc - SHORT-ACTING BRONCHODILATOR TRIAL – should be initiated immediately, lack of response
is unsual and suggests that the condition is not caused by asthma
CONSIDER: ABG and CXR
Management ACUTE:
e.g. overall plans, - MILD EXACERBATION: 1ST LINE: inhaled short-acting beta-2-agonist, adjunct: oral
referrals to other corticosteroid
services - MODERATE TO SEVERE EXACERBATION: 1ST LINE: oxygen and inhaled short-acting beta-2-
agonist, + oral corticosterioid,
SYMPTOM MANAGEMENT:
- OCCASIONAL SYMPTOMS: PEFR 100% predicted. Inhaled short acting β2 agonist as required
- DAILY SYMPTOMS: PEFR≤80% predicted. Add regular inhaled low dose corticosteroids up to
800µg daily
- SEVERE SYMPTOMS: PEFR 50-80% predicted. Add inhaled LABA (Long acting β agonist), if still
not controlled add either LTRA (Leukotriene receptor antagonist) or oral theophylline
- SEVERE SYMPTOMS: PEFR 50-80% predicted. Increase inhaled corticosteroids up to 2000µg
, daily
- SEVERE SYMPTOMS DETERIORATING: PEFR≤50% predicted. Add 40mg prednisolone daily
Prognosis Dependent on cause
Complications Drug complications e.g. salbutamol induced tremor
Rachel Farrelly [um18rf]
,1. RESPIRATORY CORE
CONDITIONS
,Disorder Acute Asthma
Definition An asthma exacerbation is an acute or subacute episode of progressive worsening of symptoms of
asthma, including shortness of breath, wheezing, cough, and chest tightness
How common is it Roughly 9% of people (5.4 million in UK)
160, 000 per annum incidence
Who does it affect 1 in 11 children – in early childhood it is higher in boys than girls in adulthood this is the other
way round
1 in 12 adults
What causes it Airway inflammation and yper-resoinsiveness – different underlying disease processes and
variations in severity, clinical course and response to treatment
Airway limitation is usually reversible, either spontaneously or with treatment
- Chronic asthma – may be irreversible as a result of wall remodelling and mucus impactation
Characterised into:
- Extrinsic: allergens can be identified by +ve skin-prick reactions to common inhaled allergens,
e.g. dust mite, pollen and fungi, in adults sensitisation to chemicals or biological products in
the workplace may be the cause
- Intrinsic: often starts in the middle age and no definite external cause can be identified, many
pts do show a degree of atopy and on close questioning give a hx of respiratory symptoms
consistent with childhood asthma
Risk Factors Personal or Fx of atopic disease – asthma, eczema, allergic rhinitis or allergic conjunctivitis
Respiratory infections in infancy
Exposure to tobacco smoke and inhaled particulates
Obesity
Social deprivation
Flour dust and isocyanates from paint
Symptoms/History Variable symptoms
Wheeze, cough, breathlessness and chest tightness
Symptoms are commonly diurnal (worse at night or early morning) and/or triggered or
exacerbated by exacerbated by exercise, viral infection and exposure to cold air or allergens
In children, it can also be triggered by emotion and laughter
In adults, it can be triggered by use of NSAIDs and B-blockers
Signs/Examination Symptomatic wheeze on auscultation
Differential Normal structures
diagnosis Skin infections
Benign tumours
Malignant primary tumours
Thyroid lumps
Salivary gland lumps
Congenital and developmental lumps carotid body tumours
Aneurysms
Trauma
Investigations 1st LINE:
e.g. to confirm - PEAK FLOW MEASUREMENT
diagnosis, exclude - O2 SATS – performed immediately
physical causes etc - SHORT-ACTING BRONCHODILATOR TRIAL – should be initiated immediately, lack of response
is unsual and suggests that the condition is not caused by asthma
CONSIDER: ABG and CXR
Management ACUTE:
e.g. overall plans, - MILD EXACERBATION: 1ST LINE: inhaled short-acting beta-2-agonist, adjunct: oral
referrals to other corticosteroid
services - MODERATE TO SEVERE EXACERBATION: 1ST LINE: oxygen and inhaled short-acting beta-2-
agonist, + oral corticosterioid,
SYMPTOM MANAGEMENT:
- OCCASIONAL SYMPTOMS: PEFR 100% predicted. Inhaled short acting β2 agonist as required
- DAILY SYMPTOMS: PEFR≤80% predicted. Add regular inhaled low dose corticosteroids up to
800µg daily
- SEVERE SYMPTOMS: PEFR 50-80% predicted. Add inhaled LABA (Long acting β agonist), if still
not controlled add either LTRA (Leukotriene receptor antagonist) or oral theophylline
- SEVERE SYMPTOMS: PEFR 50-80% predicted. Increase inhaled corticosteroids up to 2000µg
, daily
- SEVERE SYMPTOMS DETERIORATING: PEFR≤50% predicted. Add 40mg prednisolone daily
Prognosis Dependent on cause
Complications Drug complications e.g. salbutamol induced tremor
