Asthma

Question 1

When does asthma usually present?

Other times of presentation

Answer 1

Aged 5 onwards

Adult onset, occupational asthma

Question 2

Symptoms of asthma?

Answer 2

Symptoms are episodic and have diurnal variability

• SOB
• Dry cough
• Widespread polyphonic wheeze
• Chest tightness
• Reversible with bronchodilators

Question 3

Triggers for asthma?

Answer 3

• Infection
• Animals
• Mould
• Cold air
• Stress
• Exercise
• Night time/early morning

Question 4

What should the FEV1/FVC ratio be in asthma?

Answer 4

Less than 70%

Question 5

How often should peak flow be used and what is a positive result?

Answer 5

2-4 weeks

Variability of more than 20% = positive result

Question 6

What is direct bronchial challenge testing?

Answer 6

Diagnostic test for asthma - give histamine/metacholine to induce bronchoconstriction. PC20 value of 8 or less = positive resul t

Question 7

What neurotrasmitter do LAMA’s block?

Answer 7

Acetylcholine

Question 8

Example of a LTRA?

Answer 8

Montelukast

Question 9

Stepwise management of asthma?

Answer 9

SABA/LABA + ICS

2nd line: SABA + low dose LABA + ICS (MART)

3rd line: SABA + moderate dose MART

4th line: SABA+MART+LTRA/LAMA

5th line: refer to specialist asthma care

Question 10

Signs of acute asthma exacerbation

Answer 10

• Progressive SOB
• Tachypnoea
• Symmetrical expiratory wheeze
• Accessory muscle use
• Reduced air entry

Question 11

Management of acute asthma exacerbation?

Answer 11

1st line

1. If Sats < 94% → Oxygen
2. Inhaled salbutamol via spacer OR nebulised salbutamol if severe
3. If poor response to salbutamol → give ipatropium bromide
4. Abx if infective cause

2nd line

1. IV Magnesium sulphate
2. IV aminophylline
3. IV salbutamol (if life threatening)

3rd line

1. Admission to HDU or ICU
2. Intubation and ventilation

Question 12

During asthma exacerbation management what must you monitor?

Answer 12

Potassium

Lactic acidosis if tachycardic secondary to salbutamol use

Question 13

How long after discharge from asthma exacerbation should follow up in GP be done?

Answer 13

GP follow up within 48h of discharge

Question 14

Grading of asthma exacerbation severity?

Answer 14

Near fatal asthma - PaCO2 > 6

Question 15

Investigations for asthma?

Answer 15

Spirometry (FEV1:FVC < 70%)

Reversibility testing (FEV1 increases by 12% after bronchodilator = positive)

FeNO (over 40 = positive)

Peak flow

Direct bronchial challenge testing