Asthma clinical features adults and children

Question 1

what characterises asthma?

Answer 1

• increased responsiveness of the trachea and bronchi to various stimuli and manifested by a
• widespread narrowing of airways that
• changes in severity either spontaneously or as a result of therapy

Question 2

what 2 things does airway inflammation mediated by the immune system cause?

Answer 2

• widespread narrowing of airways

- increased airway reactivity (spontaneous airway narrowing or stimuli induced airway narrowing)

Question 3

what is the prevalence of asthma in children? which gender is most affected?

Answer 3

10-15%, M>F

Question 4

what is the prevalence of asthma in adults? which gender is most affected?

Answer 4

5-10%; F>M

Question 5

what is the first proven risk factor for asthma?

Answer 5

genetics; atopy-

• inherited tendency to IgE response to allergens
• asthma, eczema, hayfever, food allergy
• markers, skin prick tests, IgE

Question 6

which atopy is most influential? maternal or paternal?

Answer 6

maternal is x3 more influential than paternal

Question 7

which genes are involved?

Answer 7

• immune response genes (IL4, IL5, IgE)

- airway genes (ADAM33)

Question 8

what is the second proven risk factor for asthma?

Answer 8

occupation

Question 9

how much of the asthma of adult onset does occupation account for? what factors does it interact with?

Answer 9

10-15% of adult onset asthma, interactions with smoking and atopy

Question 10

what is the third proven risk factor for asthma?

Answer 10

smoking (including maternal smoking and smoking from grandmother)

Question 11

what causes does maternal smoking have? (without necessarily going to asthma)

Answer 11

decreased FEV1 and increased wheezy illness, airway responsiveness, asthma, severity

Question 12

how might maternal smoking affect the baby?

Answer 12

mouse work suggests epigenetic modification of ovocytes

Question 13

what is the third proven risk factor for asthma?

Answer 13

obesity

Question 14

what is a high BMI associated with?

Answer 14

asthma, wheezing, airway hyperactivity

Question 15

what is the fourth proven risk factor for asthma?

Answer 15

diet

Question 16

what diet are associated with increased risk of asthma?

Answer 16

lack of antioxidants, n-3 polyunsaturated fatty acids, too many ,-6 polyunsaturated fatty acids, variations in vitamin D intake

Question 17

what diet is decreased FEV1 associated with?

Answer 17

lack of vitamin E, C, D and beta-carotene

Question 18

what diet is increased wheeze associated with?

Answer 18

lack of vitamin E, C, lack of fruit and margarine

Question 19

what diet is increased asthma associated with?

Answer 19

lack of selenium, D, fast food and margarine

Question 20

what diet is decreased wheeze & asthma associated with?

Answer 20

increase of oily fish consumption and butter

Question 21

is supplementation in established disease effective?

Answer 21

no, changing diet is a preventive measure

Question 22

what is the fifth proven risk factor for asthma?

Answer 22

reduced exposure to microbes/ microbial products (children born on farms less likely to develop asthma)

Question 23

is microbial diversity important in reducing the risk of asthma and allergy?

Answer 23

yes

Question 24

what is the sixth proven risk factor for asthma?

Answer 24

indoor pollution: chemical household products (volatile organic compounds, formaldehyde, fragrances)

Question 25

what are the commonest environment allergens and causes of atopy/ asthma?

Answer 25

house dust mite, cat, grass pollen

Question 26

what is the particularity of cat allergen exposure?

Answer 26

evidence to show exposure maybe protective

Question 27

what could be the other causes of wheeze?

Answer 27

localised airway obstruction, inspiratory stridor, tumour, foreign body

Question 28

what could be the cause of generalised airflow obstruction?

Answer 28

asthma (reversible AFO), COPD (irreversible AFO), bronchiectasis, bronchiolitis, cystic fibrosis

Question 29

what is the typical history for asthma?

Answer 29

wheeze, SOB (dyspnoea), chest tightness, cough, paroxysmal cough, usually dry, occasional sputum

Question 30

what could trigger a variable symptom?

Answer 30

exercise, cold air, smoke, perfume, URTIs, pets, tree, grass pollen, food, aspirin, daily variation (nocturnal/ early morning), weekly variation (occupation, better at weekends & holidays?), annual variation (environmental allergens)

Question 31

how do you exclude COPD as a diagnosis?

Answer 31

gas trapping: increased residual volume and total lung capacity, RV/ TCL > 30%

Question 32

in what cases could there be no reversibility?

Answer 32

severe brochoconstriction or no bronchoconstriction

Question 33

how do you check for atopic status?

Answer 33

skin prick testing, total and specific IgE, eosinophilia (full blood count)

Question 34

how do you check for variability of airflow obstruction?

Answer 34

peak flow charts