Asthma

Question 1

Asthma is a chronic _____ _____ disease leading to variable airway obstruction

Answer 1

inflammatory airway

Question 2

When is asthma typically worse?

Answer 2

At night (diurnal variability)

Question 3

What are typical symptoms of asthma?

Answer 3

SOB
Chest tightness
Dry cough
Wheeze

Question 4

What can be heard in asthma?

Answer 4

Widespread “polyphonic” expiratory wheeze

Question 5

What are typical triggers of asthma?

Answer 5

Viral infections
Exercise
Animals
Cold
Damp air
Dust
Strong emotions

Question 6

Which drugs can exacerbate asthma?

Answer 6

NSAIDs
(They block COX-1 and COX-2 so decreased prostaglandin production so increased leukotriene production instead. Leukotrienes are bronchoconstrictors, promote mucous secretion and can cause airway inflammation.

Question 7

What is a marker of airway inflammation?

Answer 7

Nitric oxide

Question 8

What is often shown on a FBC in asthma and allergic reaction

Answer 8

Raised eosinophil count

Question 9

What is used to objectively measure lung function?

Answer 9

Spirometry

Question 10

An FEV1:FVC ratio of less than 70% suggests ________ pathology

Answer 10

obstructive
eg asthma or COPD

Question 11

A peak flow variability (from a peak flow diary) of more than __% is a positive result, supporting asthma diagnosis.

Answer 11

20%

Question 12

A greater than __% increase in FEV1 on reversibility testing supports diagnosis of asthma.

Answer 12

12%

Question 13

How do you investigate to confirm asthma in adults and children over 16?

Answer 13

FeNO or eosinophil count.
Then reversibility testing with spirometry
Then peak flow diary BD for 2 weeks
Then bronchial challenge test

Question 14

How do you investigate to confirm asthma in children aged 5-16?

Answer 14

FeNA
Reversibility testing with spirometry
Peak flow diary
Skin prick testing to house dust mite or bloods for total IgE and eosinophil count

Question 15

What is suspected asthma in under 5 y/os called?

Answer 15

Viral-induced wheeze

Question 16

Agonists to which receptors are bronchodilators?

Answer 16

Beta-2 adrenergic receptor agonists.

Question 17

Adrenaline acts on the smooth muscle of the airway to cause ______

Answer 17

Relaxation

Question 18

Activated Beta 2 receptors cause bronchodilation, so blocking B-2 receptors can prevent this and cause bronchoconstriction. That is why ______ can worsen asthma

Answer 18

non-selective beta-blockers

(rather than cardioselective beta-blockers)

Question 19

Name a common non-selective beta blocker that would make asthma worse

Answer 19

Propanolol

Question 20

Name a cardio-selective beta blocker that would be safer for asthmatics

Answer 20

Atenolol
Bisoprolol

Question 21

What medication is used as maintenance or preventer medications to control symptoms of asthma long term?

Answer 21

Inhaled corticosteroids like beclometasone

Question 22

What is a key side effect of inhaled corticosteroids?

Answer 22

Oral candidiasis

Question 23

Name a commonly used long-acting muscarinic antagonist

Answer 23

Tiotropium

Question 24

How do LAMA work?

Answer 24

Block acetylcholine receptors that are normally stimulated by parasympathetic nervous system to cause contraction of bronchial smooth muscles.

Question 25

What is a key side effect of LAMAs?

Answer 25

Dry mouth (blocking effects of parasympathetic NS such as salivating)

Question 26

What class of medication is montelukast?

Answer 26

Leukotriene receptor antagonists

Question 27

Leukotrienes are produced by the immune system and cause inflammation, bronchoconstriction and ____ ______ in the airways

Answer 27

mucous secretion

Question 28

What is a key side effect of leukotriene receptor antagonists like montelukast?

Answer 28

Neuropsychiatric reactions eg nightmares

Question 29

What does anti-inflammatory reliever (AIR) therapy involve?

Answer 29

Dry powder inhaler containing inhaled corticosteroid with fast and long-acting beta-agonist. Used PRN for patients who don't have other treatment of inhalers.

Question 30

What does MART (maintenance and reliever therapy) involve?

Answer 30

Dry powder inhaler containing ICS plus a fast and long-acting beta agonist. This inhaler is used regularly as a preventer and reliever.

Question 31

How do you take a metred dose inhaler with a spacer?

Answer 31

Assemble spacer Shake inhaler Attach inhaler to correct end Sit or stand up straight Lift chin slightly Make a seal around the spacer mouthpiece Spray dose into spacer Take steady breaths in and out 5 times until mist inhaled.

Question 32

What are life threatening features of an acute asthma attack?

Answer 32

Peak flow less than 33% Exhauster or drowsy Confused Cyanosis Hypotension Silent chest (wheeze disappears)

Question 33

How do you manage moderate exacerbations of acute asthma?

Answer 33

Inhaled beta-2 agonist (salbutamol) Consider steroids like oral prednisolone for 3-5 days

Question 34

What additional treatment is needed for severe exacerbations of asthma?

Answer 34

Oxygen to maintain sats 94-98% Nebulised salbutamol Nebulised ipratropium bromide IV magnesium sulphate IV salbutamol IV aminophylline HDU or ICU Intubation and ventilation