Asthma

Question 1

What is a blue inhaler?

Answer 1

Salbutamol - beta agonist

Question 2

Define asthma?

Answer 2

Reversible airway obstruction that cause intermittent wheezing
= Reversible obstructive airway disease

Question 3

What is a mast cell?

Answer 3

Inflammatory cell that release histamine in response to inflammatory response

Question 4

Mechanism of mast cell releasing histamine?

Answer 4

1. Allergen cross link to receptor IgE
2. Intracellular response - trigger mast cell
3. catalysis intracellular process
4. secondary messenger = mast cell degranulation
5. histamine release

Question 5

What does release of histamine cause?

Answer 5

Smooth muscle constriction = bronchoconstriction
Mucus hyper secretion - block bronchi
Mucus plug formation
Mucosal oedema

Question 6

Name different types of asthma?

Answer 6

1. Extrinsic = atopic –> pollen, house dust mite faeces
2. Intrinsic = cold, exercise, stress
3. Aspirin induced
4. Occupation - latex, animal, vapour

Question 7

What is a wheeze?

When do you get wheeze with asthma?

Answer 7

Polyphonic whistle sound

Wheeze on expirations

Question 8

What is atopy?

Answer 8

Predisposition to developing hypersensitivity type reaction

asthma, eczema

Question 9

What is SOB?

Answer 9

Shortness of breath = dyspnoea

Laboured breathing - use of accessory muscles and increased breathing rate

Question 10

What drives breathing? - does this ever change?

Answer 10

Most people CO2 drive respiration

People w/ COPD have hypoxic drive (dangerous to overload with oxygen - 1 in 200 have it and takes 4 hours to knock out)

Question 11

What is normal respiratory rate?

What rate would be classical asthma

Answer 11

12-16breath/min
Tachypnoea >20 breath/min
Asthma >25

Question 12

Symptom of severe asthma?

Answer 12

Peak flow less 50% predicted, can’t complete sentence, RR>25, HR>110

Question 13

Symptom life threatening asthma?

Answer 13

Cyanosis, exhaustion, RR less 8

Question 14

What is FEV1 and FVC?

Answer 14

FEV1= forced expiratory vol in 1 second - after full inspiration
FVC = forced vital capacity

Question 15

How measure breathing?

Answer 15

Spirometer and peak flow meter

Question 16

What expect to see in obstructive lung disease (FEV1/FVC)

Answer 16

Reduced FEV1 normal FVC

FEV1:FVC less 70%

Question 17

How diagnose asthma?

Answer 17

Show FEV1:FVC less 70%

- need to show reversible

Question 18

How to manage asthma w/ inhalers?

Answer 18

1. Reliever - manage attack by using short acting beta agonist
2. Preventer - don’t relieve attack - use long acting beta agonist

Question 19

What is the blue, brown and green inhaler?

Answer 19

Blue - salbutamol
Brown = steroid
Green = long acting

Question 20

When is ipratropium bromide used?

Answer 20

Acute attack - can be brown colour

Question 21

How does salbutamol work?

Answer 21

B2 agonist - stimulate B2 adrenoreceptor relaxing smooth muscle

Question 22

Explain step wise approach asthma?

Answer 22

1. Short acting beta agonist
2. Steroid inhaler
3. Long acting beta agonist
4. Increase steroid dose/ montelukast
5. Oral steroid - short term

Question 23

Assessing control asthma in dental setting?

Answer 23

Medication take
Admission A+E/ICU
Frequency of attack
Functional limitation

Question 24

Emergency management of acute asthma?

Answer 24

1. ABC
2. Salbutamol
3. Oxygen
4. Ambulance - hypoxic, feature severe asthma

Question 25

How is asthma tx in hospital?

Answer 25

1. High flow oxygen
2. Nebulised
3. Prednisolone - prevent late T cell response
4. No response - escalate Mg