Asthma

Question 1

Definition of asthma

Answer 1

Heterogeneous disease characterized by chronic airway inflammation with history symptoms ( cough, breathlessness, wheezes, chest tightness ) and variable expiratory airway limitation

Question 2

Which part of respiration is affected in asthma,
Inspiration or expiration

Answer 2

Expiration

Question 3

What criteria allow for diagnosis of asthma

Answer 3

More than one type of these symptoms( wheeze, Shortness of breath, Cough, Chest tightness )

Symptoms worse at night or early morning

Vary over time and in intensity

Trigger of symptoms by viral infection, exercise , allergen, weather changes, laughter , irritants ( car fumes, smoke , strong smells

Question 4

Symptoms that decrease diagnosis of asthma

Answer 4

isolated cough wiith no other respiratory symptom

Chronic production of sputum

Shortness of breath with dizziness , light headedness, peripheral tingling

Chest pain

Exercise induced Dyspnea wirh noisy inspiration stridor

Question 5

Common trigger of asthma attack

Answer 5

viral infection URTI
Pollen
Animal dander
Dust
Smoke / fumes
Strong scent
Hoist dust mite , mold
Exercise
Strong emotions
Changes in temperature
Weather changes
Stress
Occupational exposure

Question 6

Why asthma worsens at night

Answer 6

Because of cortisol level low at night which means that the body can’t fight inflammation as well as during the day when cortisol high

Question 7

Factors that increase prevalence of asthma

Answer 7

parental history of asthma or atopy

Parental smoking - maternal smoking in pregnancy

Sensitization I to aeroallergens

Widespread use of antibiotic

Western lifestyle

Urban environnement

Diet

Question 8

Factors that decrease prevalence of asthma

Answer 8

Farm environment
Older siblings
Viral infection
Earl attendance of day care during first 6 months of life
Tuberculosis

Question 9

Symptoms pattern possible in asthma

Answer 9

Episodic or continuous
Seasonal or perennial
Nocturnal

Question 10

Read pathophysiology of asthma

Answer 10

Okk

Question 11

Findings of examination in asthma

Answer 11

Normal if no exacerbation
Lung hyperinflation
Wheezing
Allergic dx (rhinitis , sinusitis, nasal polyps , eczema)

Question 12

Lung function test to demonstrated airflow limitation in asthma

Answer 12

Spirometry
Peak expiratory flow rate

Question 13

Comorbidities in asthma

Answer 13

Sinusitis
Rhinosinusitis
COPD
GERD
OSA

Question 14

How to diagnose asthma

Answer 14

Hx of symptoms
Examination
Lung function test (spirometry , PEF)
Comorbidities assessment
Broncho provocation test
Allergic states tests
FENO
FBC
CxR

Question 15

Medications/activity used in bronchoprovocation test

Answer 15

Methcholine
Histamine challenge
Post exertion state

Question 16

Differential of wheezing

Answer 16

COPD
Bronchiolitis
Cystic fibrosis
Foreign body aspiration
Thromboembolism
Bronchiectasis
Bronchopulmonary aspergillosis
Pulmonary edema
Psychogenic wheezing
LVHF

Question 17

Differentials of episodic dyspnea

Answer 17

COPD
CAD
Congestive heart failure
Pulmonary emboli
Recurrent GERD
Carcinoid syndrome

Question 18

Differential cough

Answer 18

bronchiectasis
Cystic fibrosis
Pneumonia
Rhinitis
Bronchitis
Sinusitis
Diffuse pulmonary fibrosis ]

Question 19

Management classification of asthma

Answer 19

Acute (Mild, Moderate, Severe, Life threatening )

chronic (Intermittent ,Persistent )

Question 20

Goal of management

Answer 20

Control of symptoms
Risk reduction

Question 21

Non pharmacological management of asthma

Answer 21

education
Complice ce for medication
Asthma action pl’an
Avoid précipitants
Proper inhaler techniques
Thermal bronchoplasty

Question 22

Mange ment when symptoms less than twice a month

Answer 22

Controller and reliever -> as needed low dose ICS - formoterol

Question 23

Management when Symptoms twice or more a month but less than daily

Answer 23

Controller -> daily low dose ICS or as needed low dose ICS - formoterol

Reliever -> as needed low dose ICS-formoterol

Question 24

Management when Symptoms most days or waking with asthma once a week or more

Answer 24

Controller => low dose ICS-LABA

Reliever => as needed low dose ICS-formoterol

Question 25

Management when Symptoms most days , or waking with asthma once or more a week and low une function

Answer 25

Controller => medium dose ICS-LABA Reliever => as needed low dose ICS-formoterol

Question 26

Management when severest form of asthma

Answer 26

High dose ICS -LABA Reliever -> as needed low dose ICS-formoterol

Question 27

Risk factors for severe asthma

Answer 27

non compliance Never used ICS Psychosocial factors Dysfunctional breathing (Vocal cord dysfunction ) Allergy Comorbidities Tobacco smoke. / environemental pollution ABPA

Question 28

Patients at risk of asthma related death

Answer 28

history of near fats asthma with intubation and ventilation Hospitalization or ER for asthma in last 12 months Not using ICS , poor adherence with ICS Using or recently stopped using OCS Overusing SABA Lack of written asthma action plan Hx of psychiatric dx or psychosocial problems Confirmed food allergy in patient

Question 29

What is considered severe asthma

Answer 29

asthma that requires treatment with high dose inhaled corticosteroids plus a second controller to prevent uncontrolled asthma or remains uncontrolled despite therapy

Question 30

How to evaluate acute asthma

Answer 30

• ABC ◦ Airwy ◦ Breathing ◦ Circulation • Quick hx • Examination • Acute asthma severity • Differential diagnosis ? • SPO2 , ABGs PEFR / spirometry • K+, RBS/FBS • CxR

Question 31

Signs of mild or moderate asthma

Answer 31

• talks in phrases • Prefer sitting to lying • Not agitated • Increased RR • Accessory muscles not used • Pulse rate 100-120bpm • O2 saturation 90-95% • PEF >50%

Question 32

Management of mild moderate asthma

Answer 32

SABA Ipratropium bromide O2 maintenance and control Oral corticosteroids Saturation 93-95%

Question 33

Signs of severe asthma

Answer 33

talks in words Sits hunched forwards Agitated RR more than 30/min Accessory muscles being used PR >120 bpm O2 saturation <90% PEF < 50%

Question 34

Management of severe asthma

Answer 34

SABA Ipratroprium bromide O2 maintenance 93-95% saturation Oral or IV corticosteroids IV magnesium High dose ICS

Question 35

Criteria for intubation in acute asthma

Answer 35

cardiac arrest Respiratory arrest Altered mental status Progressive exhaustion Silent chest Severe hypoxia with maximal oxygen delivery Failure to reverse severe respiratory acidosis despite intensive therapy Ph 7.2

Question 36

Complications of severe asthma

Answer 36

aspiration pneumonia Pneumomediastinum Pneumothorax Rhabdomyolysis Respiratory failure and arrest Cardiac arrest Hypoxic ischaemic brain injury