Asthma

Question 1

What is the pathology of asthma?

Answer 1

*inflamed bronchial tree
*hyper reactivity of lungs to one or more stimuli
*inflamed thick walls
*narrowed airways due to bronchoconstriction and mucosal oedema
*elevated mucus production

Question 2

What are the long term airway structure changes?

Answer 2

*sub-epithelial fibrosis
*increased smooth muscle mass
*enlarged submucosal glands

Question 3

What stimuli trigger asthma?

Answer 3

*allergens- mould, pollens
*infection- URT infections exacerbate asthma
*pollutants- cigarette smoke, sulphur dioxide, nitrous oxide
*drugs- NSAIDS- risk of bronchospasm, B blockers
*exercise- constriction due to loss of heat and moisture
*occupation- solvents, flour, paints, dust

Question 4

What are the classifications of asthma?

Answer 4

*episoidc/seasonal asthma- spring/summer when spores released?
*chronic asthma-persistent disease state with acute exacerbation’s periodically
*exercise induced- airways sensitive to colder drier air from mouth breathing
*childhood asthma- allergic reaction usually
*late onset asthma- first time in adult life- females- non allergic - higher dose corticosteroids
*status asthmaticus- long lasting severe asthma attack- can be fatal
*brittle asthma- acute catastrophic severe asthma

Question 5

What asthma is associated with IgE antibody?

Answer 5

Extrinsic/allergic asthma
Childhood

Question 6

What is intrinsic asthma?

Answer 6

Asthma of unknown origin- non-IgE related
Usually adulthood- viral infections, irritants, emotional upset (triggers parasympathetic input)

Question 7

In relation to symptoms of asthma, when are they worse?

Answer 7

Night or early morning

Question 8

How is asthma diagnosed?

Answer 8

*greater than 20% variation of PEF on > 3 days in one week over 2 week period
*reversibility test- measure function before and after B2 stimulant administered
*FeNO- increased exhaled NO levels- NOT SUPPORTED BY BTS in NICE guildlines
*skin test- indenting specific allergens
*chest radiograph- hyperinflation of lungs due to air trapping as result of mucus plugging

Question 9

How is acute severe asthma diagnosed?

Answer 9

Any ONE of
*heart rate >110bpm
*PEF 33-50% predicted
*unable to complete sentence in one breath
*hypercapnia (^CO2) , cyanosis (blue colour due to lack of O2)
*absence of wheeze- no air passing in or out

Question 10

What are non pharmacological treatments for asthma?

Answer 10

*avoid triggers
*desensitisation therapy to specific allergy
*house dust mite control
*smoking cessation
*weight reduction

Question 11

When should asthma be assessed urgently?

Answer 11

Using >1 SABA per month

Question 12

When are LABAs started?

Answer 12

When patient already taking ICS- usually combination
MART- maintainable and relieved therapy

Question 13

What are SE’s of B2 receptor agonists?

Answer 13

Tremor, tachycardia, cramps, hypokalemia (low K)

Question 14

What are examples of anti-allergic agents?

Answer 14

Sodium cromoglicate

Question 15

What are steroid sparing agents?

Answer 15

Used to reduce need for steroid treatment
-methotrexate, ciclosporin

Question 16

How should a patient monitor their condition?

Answer 16

Use a peak flow meter
*record PEF morning and night
*use a patient asthma action plan

Question 17

Why are spacers used?

Answer 17

Reduce need for synchronisation
Needed for child under 5 with any MDI
Needed for child 5-15 using any steroid- reduces deposition of lung

Question 18

At what rate are aerosol inhalers better delivered?

Answer 18

Lower respiratory flow

Question 19

At what rate are DPI’s better delivered?

Answer 19

Faster rate- needed for disaggregation of particles

Question 20

What way should a patient be monitored whilst on their drug therapy?

Answer 20

*check compliance- patient interview, check technique
*patient medication records (how frequently are they supplied, how often they use ICS or SABA/SAMA
*diary cards
*if on theophylline- close drug monitor
*PEF checks
* FEV1/ FVC ratio

Question 21

What side effects can be found using inhalers?

Answer 21

Oral candidiasis