Asthma

Question 1

Pathophysiology of Asthma? (3)

Answer 1

1. Airway narrowing due to broncoconstriction
2. Inflammation caused by mast cell degranulation
3. Increased mucus production

Question 2

List 4 symptoms of Asthma?

Answer 2

1. Dry cough with wheeze
2. Chest tightness
3. Dyspnoea
4. diurnal variation

Question 3

What Family history is linked to asthma?

Answer 3

Family history of Asthma or Hx of other atopic conditions

Question 4

List 4 signs of Asthma on examination

Answer 4

1. Chest deformities
2. Hyperinflation
3. Hyper-resonance due to hyperinflation
4. Prolonged expiratory phase with expiratory wheeze on auscultation

Question 5

Describe the pattern of symptoms in Asthma?

Answer 5

Episodic and diurnal variability of symptoms (tend to be worst at night)

Question 6

Is airway obstruction in asthma reversible or irreversible?

Answer 6

reversible

Question 7

List 4 typical triggers of Asthma

Answer 7

1. Dust (house dust mites)
2. Animals
3. Cold air
4. Exercise
5. Smoke
6. Food allergens

Question 8

Describe the wheeze heard in Asthma

Answer 8

Bilateral widespread “polyphonic” wheeze

Question 9

First line investigation for Asthma

Answer 9

Spirometry FEV1/FVC <70%

Question 10

List the investigations for Asthma

(In order)

Answer 10

1. Spirometry with reversibility testing (>5yrs)
2. Fractional exhaled nitric oxide (FeNO)
3. Direct bronchial challenge test
4. Peak flow variability

Question 11

Stepwise management of Asthma?

Answer 11

1. SABA
2. SABA + ICS
3. SABA + ICS + LRA
4. SABA + ICS + LRA + LABA
5. • MART
6. • Theophylline

Question 12

Example of a SABA?

Answer 12

Salbutamol

Question 13

Example of a LABA?

Answer 13

Salmeterol

Question 14

Example of a LRA?

Answer 14

Montelukast

Question 15

Example of a LAMA

Answer 15

Tiotropium

Question 16

What is Maintenance and Reliever Therapy (MART)

Answer 16

Combination inhaler containing low dose ICS and fast acting LABA

Replaces all other inhalers as both a “preventer” and “reliever”

Question 17

How does an Acute Asthma exacerbation present?

Answer 17

1. Progressively worsening SOB
2. Signs of respiratory distress
3. Tachypnoea
4. Expiratory wheeze on auscultation
5. Reduced air entry, chest sounds “tight” on auscultation

Question 18

What is a silent chest?

Why is it worrying?

Answer 18

Airways are so tight, it is not possible to move enough air through the airways to create a wheeze

+

Reduce respiratory effort due to fatigue

Question 19

PEFR in moderate vs severe vs life threatening Asthma

Answer 19

Moderate: 50 – 75% predicted

Severe: 33-50% predicted

Life threatening: <33%

Question 20

List 4 features of severe asthma

Answer 20

1. PEFR 33-50% predicted
2. Resp rate >25
3. Heart rate >110
4. Unable to complete sentences

Question 21

List 4 features of life-threatening Asthma

Answer 21

1. PEFR < 33%
2. Sats < 92%
3. Becoming tired
4. No wheeze - “silent chest”
5. Haemodynamic instability (i.e. shock)

Question 22

What would happen to the pO2 and pCO2 in an acute asthma attack

Incl initial changes AND prolonged changes

Answer 22

Initally: pO2 is low and pCO2 is low due to V/Q mismatch. pCO2 is low due to hyperventilation

Prolonged: pO2 is low and pCO2 is increases as ventilation is reduced by obstruction

Question 23

What will ABGs in Asthma show?

Incl initial changes AND prolonged changes

Answer 23

Initially: respiratory alkalosis

Prolonged: may progress to respiratory acidosis - very bad sign due to high CO₂

Question 24

Treatment of Moderate Asthma

(OSHI)

Answer 24

1. Oxygen
2. Nebulised Salbutamol
3. Oral prednisolone or IV Hydrocortisone
4. Nebulised Ipratropium bromide
5. Antibiotics if evidence of bacterial infection

Question 25

Treatment of Severe Asthma (OSHIT)

Answer 25

1. **O**xygen 2. Nebulised **S**albutamol 3. Oral prednisolone or IV **H**ydrocortisone 4. Nebulised **I**pratropium bromide 5. **T**iotropium Bromide 6. Antibiotics if evidence of bacterial infection

Question 26

Treatment of life threatening Asthma? (OH SHIT ME)

Answer 26

1. **O**xygen 2. Nebulised **S**albutamol 3. Oral prednisolone or IV **H**ydrocortisone 4. Nebulised **I**pratropium bromide 5. **T**iotropium Bromide 6. **M**agnesium Sulfate 7. **E**scalate

Question 27

What is the significance of a normal pCO₂ or hypoxia on ABG during a life threatening asthma?

Answer 27

Very worrying as it means the patient is tiring

Question 28

List 4 ways we can monitor response to treatment?

Answer 28

1. Respiratory rate 2. Respiratory effort 3. Peak flow 4. Oxygen saturations 5. Chest auscultation

Question 29

What must be monitored whilst on salbutamol? Why?

Answer 29

Serum K+ Salbutamol causes potassium to be absorbed from the blood into the cells. Can also causes tachycardia

Question 30

When does NICE suggest referral to a respiratory specialist for Asthma?

Answer 30

After 2 attacks in 12 months

Question 31

Explain a typical step down regime of inhaled salbutamol once control is established

Answer 31

1. 10 puffs 2 hourly then 2. 10 puffs 4 hourly then 3. 6 puffs 4 hourly then 4. 4 puffs 6 hourly They prescribe a reducing regime of salbutamol to continue at home

Question 32

Explain the direct challenge test

Answer 32

???

Question 33

How is Peak flow variability measured?

Answer 33

Patient advised to keep a diary of peak flow measurements several times a day for 2 to 4 weeks

Question 34

Gold standard investigation for diagnosis of Asthma