Asthma

Question 1

What drugs can worsen asthma? (2)

Answer 1

Non-selective beta blockers e.g. propranolol
NSAIDs

Question 2

What is seen on an ABG during an acute asthma attack? What does it change to if it’s very bad?

Answer 2

Resp alkalosis
Resp acidosis is very concerning

Question 3

What are some concerning signs in an acute asthma attack? (3)

Answer 3

Normal pCO2
Low PaO2
Resp acidosis

Question 4

What Resp disease has diurnal variation?

Answer 4

Astham

Question 5

What are the typical symptoms of asthma? (4)

Answer 5

• Shortness of breath
• Chest tightness
• Dry cough
• Wheeze

Question 6

What is the key finding on examination that indicates asthma?

Answer 6

widespread “polyphonic” expiratory wheeze.

Whistling sound with various tones

Question 7

What indicates a moderate asthma attack?

Answer 7

PEFR of 50-70

Question 8

What indicates a severe asthma attack? (4)

Answer 8

Can’t complete sentences
Hr >110
Rr >25
PEFR 33-50

Question 9

What indicates a life threatening asthma attack? (8)

Answer 9

Silent chest
Cyanosis
Exhaustion
Confusion
Poor Resp effort
PaO2 <8
Sats <92
PEFR <33

Question 10

What is the treatment for an acute asthma exacerbation?

Answer 10

O shit me

Oxygen
Salbutamol 2.5-5 g nebs
Hydrocortisone 100mg IV or prednisolone 40mg PO
Ipratropium 500mg nebs
Theophylline (aminophylline infusion)
Magnesium sulphate 2g IV over 20mins
Escalate care - intubation and ventilation

Question 11

What should be monitored with salbutamol treatment?

Answer 11

K+
Salbutamol causes K+ to be absorbed into cells so causes hypokalaemia

Question 12

What are some side effects of salbutamol? (4)

Answer 12

Fine tremor
Tachycardia
Hypokalaemia
Lactic acidosis

Question 13

What level of reversibility indicates asthma?

Answer 13

> 12% increase in fev1

Question 14

How long should a PEFR diary be kept for asthma diagnosis? What would indicate asthma from this?

Answer 14

2-4 weeks
Variability of >20%

Question 15

What FeNO supports a diagnosis of asthma?

Answer 15

> 40 ppb

Question 16

What can lower FeNO readings and cause discrepancies with asthma testing?

Answer 16

Smoking

Question 17

What are the initial investigations of asthma? (2)

Answer 17

FeNO
Spirometry with reversibility

Question 18

After first 2 tests for asthma what test is done if they are still u certain?

Answer 18

PEFR diary testing for variability

Question 19

What is the last test done if 3 previous tests are uncertain for asthma?

Answer 19

Direct bronchial challenge test with histamine or methacholine

Question 20

What is a direct bronchial challenge test?

Answer 20

Used in diagnosing asthma
Histamine or methacholine stimulates bronchoconstriction
PC20 <8mg/ml is positive result

Question 21

Give an example of a SABA?

Answer 21

Salbutamol

Question 22

What is the action of a SABA?

Answer 22

Work quickly but don’t last long
Adrenalin acts on smooth muscle and causes dilatation

Question 23

Give an example of an ICS

Answer 23

Beclomethasone

Question 24

What is the action of an ICS?

Answer 24

Reduce inflammation of airways

Question 25

What is the action of a LABA?

Answer 25

Work in same way as a SABA but last longer

Question 26

Give an example of a laba

Answer 26

Salmeterol

Question 27

Give an example of a lama

Answer 27

Tiotropium

Question 28

What is the action of a lama (long acting muscarinic antagonist)?

Answer 28

Block ACh receptors ACh receptors are usually stimulated by the parasympathetic nervous system and cause constriction of bronchial smooth muscle Blocking this results in bronchodilation

Question 29

Give an example of a leukotriene receptor antagonist

Answer 29

Montelukast

Question 30

What is the action of leukotriene receptor antagonists?

Answer 30

Leukotrienes are produced by the immune system and cause inflammation, bronchoconstriction and mucus secretion Antagonists block these effects

Question 31

How is theophylline used in asthma?

Answer 31

Theophylline. This works by relaxing bronchial smooth muscle and reducing inflammation. Unfortunately it has a narrow therapeutic window and can be toxic in excess so monitoring plasma theophylline levels in the blood is required. This is done 5 days after starting treatment and 3 days after each dose changes.

Question 32

What is maintence and reliever therapy (mart)?

Answer 32

This is a combination inhaler containing a low dose inhaled corticosteroid and a fast acting LABA. This replaces all other inhalers and the patient uses this single inhaler both regularly as a “preventer” and also as a “reliever” when they have symptoms.

Question 33

What is the BTS stepwise ladder for asthma? (5)

Answer 33

1. SABA 2. + ICS 3. + LABA / change to mart 4. Increase dose of ICS / add in Montelukast 5. Specialist advice

Question 34

Aside from medications what are the additional managements for asthma? (4)

Answer 34

• Each patient should have an individual asthma self-management programme • Yearly flu jab • Yearly asthma review • Advise exercise and avoid smoking