Asthma

Question 1

What does the word mean in greek

Answer 1

Pant heavily or gasp

Question 2

Characterisation

Answer 2

Increased responsiveness of the trachea and bronchi to stimulus, a widespread narrowing of airways that changes in severity

Question 3

Symptoms of asthma

Answer 3

Wheezing, coughing, chest tightness, shortness of breath with difficulty in expiration

Question 4

Gender

Answer 4

More male children but more female adults

Question 5

Most common chronic disease of childhood in UK

Answer 5

Asthma

Question 6

Walls of bronchi in asthma

Answer 6

Inflamed and thickened, smooth muscle tightens in an attack

Question 7

Risk factors for asthma

Answer 7

Genetics,
atopy (IgE- allergic rhinitis, asthma, hay fever and eczema)
First degree family member with it (more maternal)
Smoking, esp during pregnancy and grandmother effect
Occupation

Question 8

What is most important when making an asthma diagnosis

Answer 8

History

Question 9

Important parts of history

Answer 9

PMH, drugs, family, social, triggers, variable symptoms

Question 10

What else could ‘asthma’ be

Answer 10

Airway obstruction (general from COPD, bronchiectasis, cystic fibrosis, or localised from tumour or foreign body, inspiratory stridor) or cardiac

Question 11

If FEV1 improves with bronchodilator salbutamol

Answer 11

Asthma

Question 12

If responds to oral corticosteroids (ICS)

Answer 12

Asthma not COPD

Question 13

If normal spirometry

Answer 13

Look for variability with peak flow twice a day and chart it

Question 14

Exhaled FeNO

Answer 14

Helpful, higher with asthma

Question 15

Some useful investigations

Answer 15

IgE, skin prick, full blood count for eosinophils, chest xrays

Question 16

Moderate asthma attack

Answer 16

Can speak full sentences, HR<110, RR<25, PEF 50-75%, SaO2≥92%, PaO2≥8kPa

Question 17

Severe asthma attack

Answer 17

Can’t speak a whole sentence, HR≥110, RR≥25, PEF 33-50%, SaO2≥92%, PaO2≥8kPa

Question 18

Life threatening asthma attack

Answer 18

Grunting, impaired conscious confusion or exhaustion, bradycardia/arrhythmia/hypotension, PEF <33%, cyanosis, silent chest, poor respiratory effort, SaO2<92%, PaO2<8kPa, PaCO2 normal (4.6-6.0kPa)

Question 19

Near fatal asthma attack

Answer 19

Raised PaCO2 >6.0kPa, need for mechanical ventilation

Question 20

If quality of life is not affected

Answer 20

Watch and see

Question 21

How much is genetics

Answer 21

30-80%, 10 variants

Question 22

Differential diagnosis for asthma under 5 years

Answer 22

Congenital, cystic fibrosis, PCD, bronchitis, foreign body

Question 23

Differential diagnosis for asthma over 5 years

Answer 23

Dysfunction breathing, vocal cord dysfunction, habitual cough, pertussis

Question 24

First treatment for asthma

Answer 24

ICS

Question 25

Second treatment for asthma

Answer 25

LABA

Question 26

Third treatment (LABA not working)

Answer 26

Stop LABA, try higher ICS

Question 27

Advantages of inhalers

Answer 27

Small dose, direct delivery to target organ, faster onset, minimal systemic exposure, less systemic adverse effects

Question 28

SABA

Answer 28

reliever inhalers eg salbutamol, terbutaline (blue)

Question 29

Oral asthma therapies

Answer 29

Leukotriene receptor agonists, theophylline, prednisolone

Question 30

Specialist asthma treatments

Answer 30

Omalizumab (anti IgE) Mepolizumab (anti interleukin -5) Bronchial thermoplasty

Question 31

Treatment for moderate/severe asthma attack

Answer 31

Hospital, oral or IV steroids etc

Question 32

Contrast with COPD

Answer 32

COPD is actual lung damage, but treatment is similar

Question 33

SANE

Answer 33

S- SABA (reliever) per week A- absence from school or nursery N- nocturnal symptoms per week E- excertional symptoms per week

Question 34

Dose response for ICS

Answer 34

Logarithmic

Question 35

Adverse effects of ICS

Answer 35

Height suppression

Question 36

Inhaled dose with and without a spacer

Answer 36

5% without, 20% with

Question 37

Dry powder devices

Answer 37

Only under 8s can actually use but 20% deposition in lungs