Asthma Clinical Features (Children and Adults)

Question 1

Describe the defining features of asthma

Answer 1

A disease characterised by;

• Airway inflammation by the immune system
• Widespread narrowing of the airways
• Increased responsiveness of the trachea and bronchi –> airway narrowing –> stops spontaneously or as result of therapy

Question 2

Differentiate the main causes of wheezing illness

Answer 2

• Asthma
• Generalised airflow obstruction: COPD, bronchiectasis, CF
• Localised airway obstruction (stridor): tumour, foreign body
• Cardiac

Question 3

Define the symptoms and clinical patterns of asthma

Answer 3

• Wheeze
• SOB
• Cough: paroxysmal, usually dry
• Chest tightness
• Difficulty in expiration

Question 4

Define the specific features to be included in the clinical history of asthma

Answer 4

• Recurrent episodes
• Symptom variability
• Absence of symptoms of alternative diagnoses
• Recorded observation of wheeze
• Personal history of atopy
• Historical record of variable PEF or FEV1

Question 5

Define the investigations used to diagnose asthma

Answer 5

• Symptoms unhelpful in clinic
• Spirometry and bronchodilator reversibility
• Test for variability: PEF charting, challenge tests
• Test for eosinophilic inflammation or atopy: skin prick test, IgE

Question 6

Explain how to assess the severity of acute, severe asthma

Answer 6

(May not cause distress)

• Ability to speak
• HR
• RR
• PEF
• O2 SAT/ABG

Question 7

Contrast the management of asthma with strategies for management of COPD

Answer 7

• Consider (family, smoking) history, age, symptoms
• Treatment for both aims to control symptoms

Asthma;
- Responds better to short-acting inhaled therapy

COPD;

• Gets progressively worse: may need long term oxygen
• Smoking cessation
• Pulmonary rehabilitation

Question 8

Describe the possible factors of asthma

Answer 8

• Diet
• Obesity
• The ‘hygiene hypothesis’

Question 9

Describe the hereditary factor of asthma

Answer 9

• Atopy: body’s predisposition to produce IgE in response to allergens
• Associated with rhinitis, hay fever, asthma, eczema

Question 10

Describe how to diagnose occupational asthma

Answer 10

• Suspicion from work-related symptoms
• Work with occupational sensitiser
  Tests;
• Serial peak flow readings
• Antibodies
• Bronchial challenge test

Question 11

Explain how to diagnose occupational asthma

Answer 11

• Suspicion from work-related symptoms
• Work with occupational sensitiser
  Tests;
• Serial peak flow readings
• Antibodies
• Bronchial challenge test

Question 12

Explain how to stage acute, severe asthma

Answer 12

Moderate;

• Normal speech, HR, RR
• PEF 50-75%
• SaO2 <92% (no need for ABG)
• PaO2 >8kPa (normal = 10.3-13.3)

Severe;

• Inability to complete sentences in one breath
• HR >110
• RR >25
• PEF 33-50%
• SaO2 <92%
• PaO2 >8kPa

Life-threatening;
(Any one of)
- Grunting
- Impaired consciousness, confusion, exhaustion
- Bradycardia/arrhythmia/hypotension
- PEF <33%
- Cyanosis 
- Silent chest 
- Poor respiratory effort
- SaO2 <92% (needs ABG)
- PaO2 <8kPa
- PaCO2 normal (4.6-6kPa)

Near fatal

• Raised PaCO2
• Need for mechanical ventilation

Question 13

Describe the similarities between adult and childhood asthma

Answer 13

• Common
• Same triggers
• Same symptoms
• Same pathology
• Same treatment

Question 14

Describe the differences between adult and childhood asthma

Answer 14

• Gender
• Severe asthma
• Occupational asthma uncommon

Question 15

Name triggers of asthma

Answer 15

• URTIs
• Exercise
• Cold air
• Occupation
• Allergens