Asthma

Question 1

Is asthma an obstructive or restrictive disease?

Answer 1

Obstructive

Question 2

What happens to the basement membrane in remodelling?

Answer 2

It thickens

Question 3

What happens to the submucosa in remodelling?

Answer 3

Collagen deposition

Question 4

What happens to smooth muscle in remodelling?

Answer 4

Hypertrophy

Question 5

Asthmatics usually have a productive cough with wheeze. True/False?

Answer 5

False

Cough is usually dry/non-productive

Question 6

What is wheeze?

Answer 6

High pitched expiratory sound

Question 7

List the British Thoracic Society drug guidelines for asthma treatment

Answer 7

1. SABA
2. Inhaled steroid (Beclometasone)
3. CysLT receptor antagonist (Montelukast)
   + LABA/LAMA (Review LTRA)
   + Theophylline
4. Oral steroid

Question 8

What are the benefits of a spacer?

Answer 8

Avoids coordination problems
Reduces oropharyngeal/laryngeal effects
Reduces swallowing
Reduces particle size and velocity
Increases deposition into lungs

Question 9

CysLT antagonists (Montelukast) are more potent than inhaled steroids. True/False?

Answer 9

False

2nd line additive to inhaled steroid

Question 10

Cetirizine and Loratidine are sedative antihistamines. True/False?

Answer 10

False

They are non-sedative

Question 11

What do anti-IgE monoclonal antibody treatments (Omalizumab) do?

Answer 11

Prevent binding to IgE receptor and inhibit mediator release from basophils and mast cells

Question 12

What would be PEFR in moderate asthma?

Answer 12

Less than 80% predicted

Question 13

What would be PEFR in severe asthma?

Answer 13

Less than 50% predicted

Question 14

What would be PEFR in life threatening asthma?

Answer 14

Less than 30% predicted

Question 15

Outline management of acute severe asthma

Answer 15

Oxygen (40-60%)
Salbutamol (nebulised)
Hydrocortisone (IV)
Ipratropium (nebulised)
Theophylline (oral)
Magnesium sulphate (IV)
Anaesthetist!

Question 16

What is obstructive sleep apnoea?

Answer 16

Airway closure/obstruction during sleep, resulting in cessation of breathing

Question 17

What are some symptoms of obstructive sleep apnoea?

Answer 17

Loud snoring
Daytime sleepiness
Headache

Question 18

Obesity and COPD are not risk factors for OSA. True/False?

Answer 18

False

They are

Question 19

What is the criteria for diagnosing OSA?

Answer 19

If more than 10-15 apnoeas in any 1hr of sleep

Question 20

List features of an acute-severe asthma attack

Answer 20

Unable to finish sentences
PEFR less than 50% predicted
Tachycardia
RR more than 25 breaths/min

Question 21

List features of a life-threatening asthma attack

Answer 21

PEFR less than 30% predicted
Bradycardia, hypotension, silent chest
Exhaustion/confusion
Hypoxia, acidosis