asthma

Question 1

clinical features of asthma

Answer 1

wheeze
cough
breathlessness
chest tightness

symptoms are worse during:
night or early morning
exercise
on exposure to allergen/trigger

Question 2

pathophysiology of asthma

Answer 2

2 mechanisms:

smooth muscle contraction
- due to activation of inflammatory cells in airways when exposed to environmental allergen

airway hyper-responsiveness
- variable due to inflammatory mediators
- can be fixed due to airway remodelling

Question 3

asthma diagnosis

Answer 3

signs & symptoms - asthma probability test (6 qs)
lung function tests
peak flow diary
raised eosinophils

Question 4

define asthma

Answer 4

chronic inflammatory disorder of airways

airflow obstruction varying over short periods

Question 5

main reasons for asthma deaths

Answer 5

excessive prescribing of reliever therapy - SABA

under prescribing of preventer therapy

inappropriate LABA monotherapy

personal asthma action plans were provided to 23%

Question 6

what should good asthma control look like?

Answer 6

no daytime symptoms

no awakening at night due to asthma

no need for rescue meds (steroids/SABA)

no asthma attacks

no limitation on activity during exercise

SABA use < 3 times a week

Question 7

what is wrong with SABA overuse

Answer 7

increases exercise-bronchoconstriction

promotes airway inflammation

worsens asthma control

associated with increased asthma mortality

Question 8

why not treat with SABA alone?

Answer 8

SABA was 1st line treatment for 50 years - asthma was incorrectly thought as disease of bronchoconstriction

SABA use reinforced as it provides rapid relief of symptoms

its use trains patients it is the primary treatment for asthma - but does not address the underlying cause

subsequent introduction of ICS - leads to further non-adherence due to its side effects

Question 9

importance of as-needed low dose ICS (formoterol) in mild asthma?

Answer 9

compared with as needed SABA
- reduced risk of severe exacerbation

compared with maintenance low dose ICS
- similar risk of severe exacerbation

Question 10

guidelines for managing asthma

Answer 10

SABA free pathway (preferred)
step 1 - low dose ICS/bronchodilator

2) moderate dose ICS/LABA

using combination ICS/LABA inhaler instead of ICS & SABA separate inhalers reduces risk of exacerbation and SABA overuse

3) moderate dose ICS/LABA/LAMA
or
high dose ICS/LABA

4) high dose ICS/LABA/LAMA

SABA pathway
- rescue/as needed SABA used in addition to preventer therapy

• SABA-free can only be for step 1 and 2, for step 3 seek specialist advice and move to SABA pathway as rescue/needed

Question 11

adherence in asthma and factors contributing to nonadherence

Answer 11

approximately 50% of patients are nonadherent

medication factors - difficulty with device, cost, multiple devices

unintentional - lack of understanding, forgetfulness

intentional - cost, religious beliefs, anger