Asthma

Question 1

what is asthma?

Answer 1

chronic inflammatory airway disease charcterised by intermittent airway obstruction and hyper-reactivity. the airflow obstruction is reversible

Question 2

what are the symptoms in asthma?

Answer 2

intermittent SOB 
wheeze (expiratory) 
Cough 
Sputum production 
Acid reflux (40-60%)

Question 3

what are the signs of asthma?

Answer 3

tachypnoea 
wheeze 
hyperinflated chest 
hyperresonant percussion 
decreased A/E

Question 4

what are the important points in an asthma history?

Answer 4

precipitants e.g cold air, exercise, allergens

Diurnal variation - in symptoms or peak flow. often worse in morning

Disturbed sleep

Effect on school/job/life

Question 5

what are the investgations in asthma?

Answer 5

PEF
- diurnal variations of >20% on >3 days per week for 2 weeks. lower than normal for age and height

Spirometry

• FEV1/FVC of <80% predicated
• > 15% improvement in FEV1 after salbutamol

CXR
- hyperinflation. can be normal

FBC
- raised eosinophils and/or neutrophilia

skin prick allergy testing

Question 6

what are the treatment steps in asthma?

Answer 6

step 1 = SABA PRN. If used more than once a day or nightime then move to step 2

Step 2 = add inhaled corticosteroid e.g beclometasone or budesonide

Step 3 = LABA e.g salmeterol. Increase steroid dose to max of 800ug a day before;

Step 4 = increase beclometasone to 2000ug/day. Then add theophylline, Leukoriene receptor antagonist (montelukast) or anti-IgE MAB (omalizumab)

Step 5 = oral prednisolone

Question 7

how do B2 receptor agonist work in asthma? what are SEs?

Answer 7

increase cAMP leading to broncial SM relaxation

tremor, hypokalaemia, tachyarrhythmias

Question 8

what are the S&S of acute asthma exacerbation?

Answer 8

cough, wheeze, SOB

progressive chest tightness 
tachycardia 
RR >25 
silent chest - loss of wheeze 
accessory muscle use

Question 9

how is acute asthma treated?

Answer 9

oxygen
5mg salbutamol nebs and 0.5mg ipatropium bromide nebs
oral prednisolone 40mg or IV hydrocortisone 100mg
IV magnesium sulphate
ICU referral after that

Question 10

what are the signs of a moderate asthma attack?

Answer 10

• Increasing symptoms;
• Peak flow > 50-75% best or predicted;
• No features of acute severe asthma.

Question 11

what are the features of severe acute asthma ?

Answer 11

Any one of the following:

• Peak flow 33-50% best or predicted;
• Respiratory rate ≥ 25/min;
• Heart rate ≥ 110/min;
• Inability to complete sentences in one breath.

Question 12

what are the features of life threatening asthma?

Answer 12

any 1 of in patient with severe asthma

PEF <33% best or predicted 
 	SpO2 < 92% 
 	PaO2 < 8 kPa 
 	Normal PaCO2 (4.6–6.0 kPa) 
 	Silent chest 
 	Cyanosis 
 	Feeble respiratory effort 
 	Bradycardia 
 	Dysrrhythmia 
 	Hypotension 
 	Exhaustion 
 	Confusion 
 	Coma