Asthma

Question 1

Define Asthma

Answer 1

Hyperresponsive airway to certain enviromental allergens triggering smooth muscle contraction and an inflammatory response which leads to airway narrowing that is reversible spontaneously or by therapy

Question 2

What are the symptoms of asthma?

Answer 2

Wheeze
Cough
~Sputum
Breathlessness

Question 3

Signs of Asthma?

Answer 3

Cant speak full sentences in one breath
Tachypnoea
Tachycardia
Hyperinflation

Question 4

How is chronic asthma investigated?

Answer 4

Spirometry - Lower FEV1/FVC & Lower PEF
Peak flow monitoring - 2 or 3xday for 2 weeks
PFT - Helium Dilution & CO transfer
Bronchodilator Test - First SABA then inhaled CCS
Atopy Test - Family or personal history of atopic disease, skin prick test, FBC (eosinophilia) and total & specific IgE.
ETT - See if you can give them an attack

Question 5

How is chronic asthma managed?

Answer 5

Weight loss - Exercise - Smoking cessation - Bronchial Thermoplasty - Asthma Action Plan - Allergen avoidance - Influenza/pneumococcal vaccination

SABA (reliever)
Inhaled CCS (preventer)
LABA or LKRA if severely atopic
LAMA
Oral Steroids - Prednisalone
Aminophylline
Monoclonal Antibodies

Question 6

What drugs must be avoided with an asthma patient?

Answer 6

Beta blockers
NSAIDS
Aspirin
Sedative & Opiates

Question 7

How is an acute asthma attack investigateD?

Answer 7

Determine severity of symptoms by:

• Ability to speak
• Resp Rate (Tachy or in extreme cases hypoventilating)
• HR rate (Tachy or in extreme cases brady)
• O2 Sat (scared if drops below 92%)
• ABG for PaO2 (Want above 8kPa) [In extreme cases PaCO2 above 6kPa]
• PEF (Want atleast 75%)
• Any confusion/exhaustion/impaired consciousness

Question 8

How is an acute asthma attack treated?

Answer 8

Nebulised SABA & SAMA (ipratropium bromide) with O2
Oral and or IV steroids (keep prednisalone for 7 days post attack)
Adrenaline
~IV MgSO4
~Aminophylline
~Extra corporeal CO2 removal (ECCO2R)

Question 9

What test can we do for asthma in the moment that sucks balls for the patient?

Answer 9

Bronchial Challenge Test:
Nebulised Methycholine or histamine inhalation triggers bronchoconstriction, previously sensitised people will react to a much lower dose of the drug.