Asthma

Question 1

Consider _ for sudden onset of wheezing without a hx of asthma.

Answer 1

Anaphylaxis

Question 2

Consider _ for child with their first wheezy episode, or unilateral wheeze.

Answer 2

FBAO

Question 3

_ people per year in the UK die due to asthma.

Answer 3

2000

Question 4

Risk factors for developing near fatal asthma:

Answer 4

Medical:
Previous near fatal episode (ventilation, respiratory acidosisi)
Previous ICU admission
Previous hospital admission (esp if using 3+ classes of asthma medication)
Anaphylaxis
High Beta2 agonist requirements, with little or no effect
Repeated ED admission in 12 months
Brittle asthma
Psychological/Behavioural:
Non compliance with treatment/monitoring/GP
Self discharge from hospital
Psychosis, depression, other psychiatric illness and self harm
Alcohol, drug use, smoking, obesity
Social problems and stressors

Question 5

Life threatening asthma (Any 1 in addition to severe asthma):

Answer 5

Reduced LOC
Exhaustion
Cyanosis
Silent chest
Poor respiratory effort
PEF<33% of best
SPO2 <92%
Arrythmia
Hypotension

Question 6

Acute severe asthma: (Any 1 of:)

Answer 6

PEF 33-50% of best
Inability to complete sentences in one breathe
Pulse >110 adults
Pulse >125 in over 5s
Pulse >140 in 1-5s
Resps >25 adults
Resps >30 in over 5s
Resps >40 in 1-5s

Question 7

Moderate asthma:

Answer 7

Able to speak in sentences
Increasing symptoms
PEF 50-75% of best
No features of acute severe
Pulse and resps lower than acute severe

Question 8

Mild asthma:

Answer 8

Below usual functioning due to a wheeze
PEF >75% best
No features of worsened categories

Question 9

Asthma is caused by:

Answer 9

Inflammation, and therefore narrowing, of the bronchi. The muscles becoming irritated and contracting causes sudden worsening. The mucus glands get irritated and can produce excessive sputum, causing productive cough and further blockage.

Question 10

Inspiratory or expiratory wheeze?

Answer 10

Expiratory

Question 11

Why is the wheeze only expiratory?

Answer 11

During inspiration, the muscles of respiration are being used and a blockage is overcome by the air moving inward.
On expiration, the muscles relax, and the airways are narrowed, causing delayed expiration and expiratory wheeze.

Question 12

When to give IB:

Answer 12

When unresponsive to salbutamol.