Asthma

Question 1

the most common chronic respiratory disorder

Answer 1

asthma

Question 2

asthma

Answer 2

chronic inflammatory disorder of the airways

secondary to type 1 hypersensitivity

variable and recurring symptoms manifest as reversible bronchospasm resulting in airway obstruction.

Question 3

asthma risk factors

Answer 3

atopy

antenatal factors:
- maternal smoking
- maternal viral infection (RSV)

birth factors:
- low birth weight
- not being breastfed

environmental:
- smoke
- allergens (house dust mite)
- air pollution

‘hygiene hypothesis’:

Question 4

number of patients with asthma are sensitive to?

Answer 4

aspirin

Question 5

patients who are most sensitive to asthma often suffer from?

Answer 5

nasal polyps

Question 6

asthma signs & symptoms

Answer 6

symptoms: cough (nocturnal), dyspnoea, wheeze

signs:
auscultation: expiratory wheeze

PEFR (peak expiratory flow rate): reduced

Question 7

typical spirometry results in asthma?

Answer 7

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

Question 8

asthma adults investigations

Answer 8

exclude occupational asthma

spirometry + a bronchodilator reversibility (BDR) test

FeNO test

Question 9

asthma children (5-16 y/o) diagnosis

Answer 9

spirometry + a bronchodilator reversibility (BDR) test

FeNO test

Question 10

asthma children (<5 y/o) diagnosis

Answer 10

clinical judgement

Question 11

FeNo positive test

Answer 11

in adults level of >= 40 parts per billion (ppb)

in children a level of >= 35 parts per billion (ppb

Question 12

what does a reversbility test measure?

Answer 12

FEV1

Question 13

positive reversibility test

Answer 13

FEV1 improvement of 12% or more

Question 14

how does FeNO work?

Answer 14

nitric oxide is produced by 3 types of nitric oxide synthases (NOS).

one of the types is inducible (iNOS) and levels tend to rise in inflammatory cells, particularly eosinophils

levels of NO therefore typically correlate with levels of inflammation.

Question 15

asthma management in adults

Answer 15

1. SABA
2. SABA + ICS
3. SABA + ICS + LTRA
4. SABA + ICS + LABA

continue LTRA depending on patient’s response to LTRA

Question 16

maintenance and reliever therapy (MART)

Answer 16

a form of combined ICS and LABA treatment

a single inhaler (ICS + LABA) used for daily maintenance therapy and the relief of symptoms as required

Question 17

Describe low, moderate and high doses of ICS

Answer 17

<= 400 micrograms budesonide or equivalent = low dose

400 micrograms - 800 micrograms budesonide or equivalent = moderate dose

> 800 micrograms budesonide or equivalent= high dose

paeds 200/ 200-400/ >400

Question 18

asthma management in <5

Answer 18

1. SABA
2. SABA + an 8-week trial of MODERATE-dose inhaled corticosteroid (ICS)
3. SABA + low-dose ICS + LTRA
4. Stop the LTRA and refer to an paediatric asthma specialist

Question 19

when should we consider stepping down asthma treatment?

Answer 19

every 3 months or so

take into account duration of treatment, side-effects and patient preference

Question 20

when reducing the dose of inhaled steroids the BTS advise us to do this by what increments?

Answer 20

25-50%

Question 21

acute asthma features

Answer 21

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

Question 22

moderate acute asthma

Answer 22

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

PSPR

Question 23

severe acute asthma

Answer 23

PEFR 33 - 50% best or predicted
speech: can’t complete sentences
Pulse > 110 bpm
RR > 25/min

PSPR

Question 24

life-threatening acute asthma

Answer 24

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

PSPR

Question 25

normal pCO2 in an acute asthma attack is a good sign

Answer 25

FALSE | indicates exhaustion and should, therefore, be classified as life-threatening.

Question 26

near-fatal asthma

Answer 26

fourth category | characterised by a raised pC02 and/or requiring mechanical ventilation with raised inflation pressures

Question 27

important step in further assessment of acute asthma?

Answer 27

arterial blood gases for patients with oxygen sats < 92%

Question 28

CXR is routinely performed in acute asthma attacks

Answer 28

not routinely recommended unless: life-threatening asthma suspected pneumothorax failure to respond to treatment

Question 29

when should patients be admitted to hopsital?

Answer 29

life-threatening asthma severe acute asthma & fail to respond to initial treatment previous near-fatal asthma attack pregnancy attack despite using oral corticosteroid presentation at night

Question 30

acute asthma attack management

Answer 30

oxygen: 15L of supplemental via a non-rebreathe mask SABA hydrocortisone or prednisolone (40-50mg) for at least five days ipratropium bromide IV aminophylline IV magnesium sulphate ITU/HDU

Question 31

acute asthma attack discharge criteria

Answer 31

stable on their discharge medication (no nebulisers or oxygen) for 12–24 hours inhaler technique checked and recorded PEF >75% of best or predicted

Question 32

asthma in children: how do you assess acute attacks?

Answer 32

severe attack or life-threatening attack

Question 33

severe asthma attack in kids

Answer 33

SpO2 < 92% PEF 33-50% best or predicted Too breathless to talk or feed Heart rate >125 (>5 years) >140 (1-5 years) Respiratory rate >30 breaths/min (>5 years) >40 (1-5 years) Use of accessory neck muscles

Question 34

life threatening asthma attack in kids

Answer 34

SpO2 <92% PEF <33% best or predicted Silent chest Poor respiratory effort Agitation Altered consciousness Cyanosis

Question 35

chemicals associated with occupational asthma

Answer 35

isocyanates - most common cause spray painting and foam moulding using adhesives platinum salts soldering flux resin glutaraldehyde flour epoxy resins proteolytic enzymes