Asthma

Question 1

What are the symptoms of asthma?

Answer 1

Wheeze
SOB
Cough
Chest tightness
Variable expiratory airflow limitation

Question 2

What are the main categories of medication use in asthma?

Answer 2

Beta agonists - works on smooth muscle to relax airways

Corticosteroids - reduced influx of inflammatory cells e.g. eosinophils. Prevents the release of inflammatory mediators that would cause airway contsriction

Question 3

What are some bronchodilators?

Answer 3

Relievers

SABA - salbutamol, bricanyl

LABA - salmetarol, formoterol

Question 4

What are some corticosteroids?

Answer 4

Controllers

ICS - beclomethasone, flucticasone

Question 5

What are the processes of personalised asthma management?

Answer 5

Assess

• confirm diagnosis
• symptom control/modifiable RFs
• Inhaler technique/adherene

Adjust

• Treatment of modifiable RFs and co-morbidities
• Non-pharmacological strategies
• Asthma medications
• Education and skills training

Review

• Symptoms
• Exacerbations
• Side-effects
• Lung function
• Patient satisfactions

Question 6

What investigations are done for asthma?

Answer 6

Spirometry: FEV1 and FVC
FeNO
Maybe CXR in older patients with history of smoking

Question 7

What is FEV1?

Answer 7

volume that has been exhaled at the end of the first second of forced expiration

Question 8

What is FVC?

Answer 8

olume that has been exhaled after a maximal expiration following a full inspiration

Question 9

What results are typically seen on spirometry in asthma?

Answer 9

FEV1 - significantly reduced
FVC - normal
FEV1% (FEV1/FVC) < 70%

Question 10

What does FeNO levels correlate with?

Answer 10

Inflammation - produced by inflammatory cells in the lungs

Question 11

What are the features of SABAs?

Answer 11

e.g. Salbutamol 
First line
Used when symptoms develop
Blue 'reliever' inhaler 
Relax smooth muscle of airway

Question 12

What are the side effects of SABAs?

Answer 12

Tremor

Question 13

When are ICS’s used?

Answer 13

When asthma is not controlled by SABA alone
Taken everyday regardless of symptomatic or not
‘preventer’

Question 14

What are side effects of ICS’s?

Answer 14

Oral candidiasis

Stunted growth

Question 15

What class of drug is montelukast?

Answer 15

Leukotriene receptor agonist

Question 16

What is considered a positive FeNo result?

Answer 16

in adults level of >= 40 parts per billion

in children a level of >= 35 parts per billion

Question 17

What is the management for newly diagnosed asthma?

Answer 17

SABA

Question 18

What is the management for asthma not controlled by SABA?

Answer 18

SABA + low dose ICS

Question 19

What is step three in asthma management?

Answer 19

SABA + low-dose ICS + leukotriene receptor antagonist e.g. Montelukast

Question 20

What is step 4 in asthma management?

Answer 20

SABA + low-dose ICS + LABA

continue leukotriene receptor antagonist e.g. Montelukast if helpful

Question 21

What is step 5 in asthma management?

Answer 21

SABA +/- LTRA

Switch ICS/LABA for maintenance and reliever therapy (MART)

Question 22

What is MART?

Answer 22

a form of combined ICS and LABA treatment in which a single inhaler

Question 23

What are the features of acute asthma?

Answer 23

worsening dyspnoea, wheeze and cough that is not responding to salbutamol
maybe triggered by a respiratory tract infection

Question 24

How do we stratify acute asthma?

Answer 24

Moderate
Severe
Life threatening

Question 25

What are the features of moderate acute asthma?

Answer 25

PEFR 50-75% best or predicted Speech normal RR < 25 / min Pulse < 110 bpm

Question 26

What are the features of severe acute asthma?

Answer 26

PEFR 33 - 50% best or predicted Can't complete sentences RR > 25/min Pulse > 110 bpm

Question 27

What are the features of life-threatening acute asthma?

Answer 27

``` PEFR < 33% best or predicted Oxygen sats < 92% Silent chest, cyanosis or feeble respiratory effort Bradycardia, dysrhythmia or hypotension Exhaustion, confusion or coma ```

Question 28

What is the management for acute asthma?

Answer 28

Life-threatening - admission Severe - admit if refractory to initial treatment O2 if hypoxaemic (15L non-rebreathe mask) high dose SABA 40-50mg prednisolone orally Ipratropium bromide if above not satisfactory IV magnesium sulphate

Question 29

What is ACOS?

Answer 29

Asthma-COPD overlap syndrome Worse symptoms and QoL Increased risk of exacerbations

Question 30

How is ACOS defined?

Answer 30

Persistent airflow obstruction with features of asthma