Asthma

Question 1

Allergens that can be responsible for asthma attacks

Answer 1

cats
house dust mite
pollen

Question 2

Pathological changes to airways in asthma

Answer 2

thickening of basement membrane
mucous gland hyperplasia
desquamation of epithelium
mucous plug formation
hypertrophy of smooth muscle
oedema of mucosa and submucosa, infiltration with eosinophils and neutrophils

Question 3

Asthma symptoms

Answer 3

wheeze
dyspnoea
cough (may be nocturnal)
chest tightness
diurnal variation (symptoms often worse in mornings)

Question 4

What is asthma associated with?

Answer 4

FH atopy
eczema
allergic rhinitis
nasal polyps
aspirin intolerance

Question 5

What is Samter’s triad?

Answer 5

asthma
nasal polyps
aspirin intolerance

Question 6

What can exacerbate asthma symptoms?

Answer 6

exercise
NSAIDs
Beta-blockers

Question 7

Asthma signs

Answer 7

tachypnoea
hyperinflated chest
hyper-resonance on chest percussion
decreased air entry
wheeze on auscultation

Question 8

Signs of severe asthma attack

Answer 8

inability to speak in complete sentences
respiratory rate >25
peak flow 33-50% predicted

Question 9

Signs of life-threatening asthma attack

Answer 9

silent chest
confusion
bradycardia
cyanosis
exhaustion

Question 10

Which investigations are done in chronic asthma?

Answer 10

peak flow - variability >20%
fractional exhaled nitric oxide (FeNO) - >40ppb in adults, >35ppb in children
spirometry - FEV1/FVC <0.7 (obstructive spirometry)

Question 11

Which investigations should be ordered in an acute asthma attack?

Answer 11

ABG - type 2 respiratory failure (low PaO2, high PaCO2) = sign of life-threatening attack

Routine blood tests - look for precipitating cause of attack (eg. infection)

Chest xray - exclude differentials + possibly identify precipitating infection

Question 12

Acute asthma attack management

Answer 12

ensure patent airway
ensure oxygen saturations 94-98%
nebulisers (salbutamol, ipratropium)
steroids (oral prednisolone, or if severe IV hydrocortisone)
IV magnesium sulphate if severe
IV aminophylline if severe and inadequate bronchodilatory response from nebulisers

Question 13

Non-pharmacological management of chronic asthma

Answer 13

smoking cessation
avoidance of precipitating factors (eg. known allergens)
review inhaler technique

Question 14

How can disease control be monitored?

Answer 14

RCP 3 questions
asthma control questionnaire (ACQ)
asthma control test (ACT)
mini-asthma quality of life questionnaire (AQLQ)

Question 15

Differential diagnoses for asthma

Answer 15

vocal cord dysfunction (eg. paradoxical vocal cord movement)
dysfunctional breathing (eg. hyperventilation syndrome)
GORD (reflux-related cough/breathlessness)

Question 16

What is a SABA and give some examples

Answer 16

short-acting beta agonist
salbutamol
terbutaline

Question 17

What is a LABA and give some examples

Answer 17

long-acting beta agonist
salmeterol
formoterol
vilanterol

Question 18

What is a LAMA and give an example

Answer 18

long-acting muscarinic antagonist
tiotropium

Question 19

List 4 corticosteroids that can be inhaled

Answer 19

beclamethasone
fluticasone
budesonide
ciclesonide

Question 20

What drug is anti-IgE?

Answer 20

Omalizumab

Question 21

What drug is anti-IL5?

Answer 21

Mepolizumab

Question 22

What are the key elements to look for in an asthma review?

Answer 22

check peak flow (PEFR)
ask them to show you their inhaler technique
triggers
occupation
smoking

Question 23

How is hyperinflation seen on CXR?

Answer 23

> 6 anterior ribs seen above diaphragm