Asthma 01.15

Question 1

Two year old with 1st episode wheeze at 6 months
• 5 further episodes associated with URTIs
• No other chest symptoms
Fever <38.5
•Weight gain good

Answer 1

Broncholitis - commonest acute LRTI in infancy.

Question 2

In 2 year old:
Respiratory distress- tachypnoea
- grunting
- subcostal & intercostal recession
- tracheal tug
- nasal flaring
• Hyperinflation with palpable liver edge
• Widespread fine crepitations throughout respiratory cycle
• Often prolonged expiratory phase with wheeze
• Hypoxia
• Fever in most (

Answer 2

Broncholitis - commonest acute LRTI in infancy.

Question 3

3 year old with:
Exercise – wheeze, cough, SOB, tight chest
• Nocturnal cough
• ‘tummy ache’
• Wheeze with URTIs
• Nasal symptoms
• Atopy – eczema, hayfever, food allergies

Answer 3

Asthma - atopic

Question 4

Signs you would expect in child with chronic asthma untreated:

1. Fingers?
2. Growth chart?
3. Skin?
4. Chest & ribs?
5. Face?

Answer 4

Fingers - Clubbing
Grow chart -  Failure to thrive
Chest - Harrison sulci, barrel chest
Skin - Ezcema
Face - Allergy – shiners (from constantly rubbing eyes), nasal crease (constantly wiping / rubbing nose), salute sign

Question 5

Which type of CD4+ T helper cell is pro-atopic and pro-asthmatic? Th1 or Th2

Answer 5

Th2

Question 6

Once an allergen has been presented to Th2 cell by dendritic cell, Th2 cell stimulates activity of what 3 cell types, causing inflamm. response?

Answer 6

1. Eosinophils
2. Mast cells
3. B cells - IgE

Question 7

4 key symptoms of asthma

Answer 7

1. wheeze
2. SOB
3. chest tightness
4. cough

Question 8

What would you expect on a peak flow chart over a week?

Answer 8

Diurnal variation - lowest reading in morning “morning dippers”

Question 9

Mast cell production of histamine, prostoglandins and leukotrienes occurs within minutes and causes what physiological response & what symptom of asthma (2)

Answer 9

Bronchoconstriction

Wheeze

Question 10

Cytokines IL 4 and IL 13 are produced within hours by mast cells, causing what cellular and what physiological probs (2)

Answer 10

Eosinophil recruitment

Mucous production

Question 11

What stage of asthma severity is this (1-4):
80% expected,
<2 nocturnal epis. / month

Answer 11

Stage 1 - Intermittant

Question 12

What stage of asthma severity is this (1-4):
>1/wk, but less than 1/day
FEV1 / PEF >80% expected, variability 20%-30%
Nocturnal symp >2/mo

Answer 12

Stage 2 - Mild persistant

Question 13

What stage of asthma severity is this (1-4):
Daily attacks, affect activity
FEV1 / PEF 60-80% expected,
Nocturnal symp >1/week

Answer 13

Stage 3 - Moderate persistent

Question 14

What stage of asthma severity is this (1-4):
Continuous attacks, limit phys activity
FEV1 / PEF <60% expected,
Nocturnal symp frequent

Answer 14

Stage 4 - Severe persistent asthma

Question 15

This asthma treatment is a SABA (short acting beta agonist)

Increases cAMP production - relaxation of sm muscle

Answer 15

Salbutamolin (ventolin) / terbutaline also

Question 16

Other than bronchodilation what are 2 other effects of salbutamol

Answer 16

Incr mucus clearance

Inhib inflamm cytokines

Question 17

S/E salbutamol (3)

Answer 17

Tremor
Tachycardia
Hypokalaemia

Question 18

Give 1 example of each of the following asthma medications:

1. SABA
2. Corticosteroid
3. LABA
4. Leukotriene receptor agonist
5. Xanthines

Answer 18

1. SABA - Salbutamol
2. Corticosteroid - Beclometasone
3. LABA - Salmeterol
4. Leukotriene - Montelukast
5. Xanthine - Theophylline

Question 19

Therapeutic effects of corticosteroids for asthma (3)

Answer 19

1. Reduce immune cell numbers (eosin. T lymph etc)
2. Red. inflammatory mediators
3. Red. vascular permeability

Question 20

S/E corticosteroids in LONG term use (4)

Answer 20

Osteoporosis
Incr infection risk
Hyperglycaemia
Growth retard. in kids

Question 21

S/E corticosteroids in SHORT term use (2)

Answer 21

Candida oral infection

Sore throat

Question 22

Fluticasone and budesonide are what type of asthma drug

Answer 22

corticosteroids

Question 23

What must ALWAYS be used in combination with a steroid for asthma treatment

Answer 23

LABAs e.g salmeterol

Question 24

Symbicort (Red/white), Seretide (purple) and Fostair (brown) are examples of what type of inh.

Answer 24

Combination steroid and LABA - preventer and reliever

Question 25

3 therapeutic effects of Leukotriene receptor antagonists

Answer 25

1. Red wheeze & bronchoconstriction 2. Reduce eosin. and basophil 3. Red. mucus & microvasc leakage

Question 26

S/E of montelukast etc (2)

Answer 26

GI disturb | Headache

Question 27

Xanthines - therap. effect?

Answer 27

Red inflamm mediators

Question 28

SE Xanthines (very narrow therap window) (4)

Answer 28

1. Naus & vom 2. Tachycardia 3. Convulsions 4. Coma!

Question 29

Maj. interaction of Xanthines

Answer 29

Macrolides e.g clarithromycin - incr. blood levels of theophyliine

Question 30

What is Omalizumab and how does it help with asthma

Answer 30

Monocl antibody - bind to IgE prevent interact with mast cells.

Question 31

4 maj risks of steroid use in children

Answer 31

1. Cushings 2. Adrenal suppression 3. Fungal in mouth 4. Reduc. resist to chickenpox (h.zoster)

Question 32

This drug can be nebulised for severe acute asthma attacks

Answer 32

Ipratropium (anti-muscarinic)

Question 33

This dryg can be given IV for severe acute asthma attacks

Answer 33

IV magnesium sulphate

Question 34

Phosphodiesterase inhibits cAMP and therefore inhibits relaxation of sm muscle. Which drug inhibits phosphodiesterase, thus helping sm musc relaxation?

Answer 34

Xanthines eg Theophylline

Question 35

What is FEV1

Answer 35

Forced Epired Vol in 1 sec - amount breathed out in 1 second from FULL INSPIRATION

Question 36

What is FVC

Answer 36

Forced Vital Capacity - Amount of air expired in WHOLE BREATH from FULL INSPIRATION

Question 37

What is PEFR

Answer 37

Peak Expiratory Flow Rate (L/s) = percentage figure of expected rate in a healthy individual. e.g. Mild asthma - expect PEFR >80% In Severe it can be <60%

Question 38

Below what age are lung function tests less reliable

Answer 38

5years

Question 39

Name 2 obstructive disorders and 2 restrictive disorders

Answer 39

Obstructive: Asthma, Cystic Fibrosis, COPD Restrictive: Severe kyphosis, pleurisy, diaphragmatic hemiparalysis

Question 40

4 clinical features used to distinguish COPD from Asthma

Answer 40

1. COPD - chronic cough 2. Asthma - reversibility with inhalers 3. Smoking history - COPD 4. Nocturnal variation - asthma

Question 41

DD for Chronic cough +/- wheeze in under 1yo (5)

Answer 41

1. Bronchiolitis 2. Pertussis (hooping cough) / other infection 3. GORD 4. Transient early wheeze 5. Cf others. ..

Question 42

This virus is: The commonest acute lower respiratory tract infection in infancy. • Respiratory Syncytial Virus (RSV) in 80% cases, others adenovirus, influenza and parainfluenza virus. • Winter months. • Necrosis of the ciliated cells and proliferation of non-ciliated cells. • Bronchiolar obstruction, atelectasis and hyperinflation • Leads to hypoxia, hypercarbia and ventilation

Answer 42

Broncheolitis

Question 43

DD for chronic cough +/- wheeze in pre-school kids <5yo (7)

Answer 43

``` 1. Transient early wheeze 2, Asthma 3. Infections – Recurrent Viral URTIs – Bacterial (pertussis or persistent collapse – TB 4. Inhaled foreign body 5. Passive smoking 6. Cystic fibrosis + bronchiectasis 7. GORD others... ```

Question 44

``` 7 yr old Wheezy since 3 yrs with URTIs • Infantile eczema • Allergy reaction to egg at 14 months • Wheezy when visits grandma who has a cat • Treatment – bronchodilator prn • Recently waking with cough at night • Most likely diagnosis? ```

Answer 44

Asthma Recurrent viral URTIs others...