Asthma: Adult and Children

Question 1

Describe the defining features and epidemiology of asthma, its proven and putative aetiological factors

Answer 1

• variable airway narrowing/inflammation/oedema/irritability

- genetic atopy/occupation/smoking in pregnancy

Question 2

Differentiate the main causes of wheezing illness

Answer 2

wheeze is common in any condition with localised airway obstruction

asthma dx is all in the history

Question 3

Discuss possible reasons for the changing prevalence and severity of respiratory disease with child’s age and possible links with respiratory disease in adult life

Answer 3

• respiratory tracking in adult life
• impaired lungs in early life can present later on
• as the child’s lungs grow, the condition may be exacerbated

Question 4

Describe the symptoms and clinical patterns of asthma lung, and show how this affects the O2 alveolar gas

Answer 4

• wheeze on exertion
• worse lung function in morning
• waking up breathless at night
• variable
• possible psycho-social aspect

causes low in alveolar O2

Question 5

Define the specific features to be included in the clinical history of asthma

Answer 5

• triggers
• daily/weekly/annual
• wheezing sound on expiration
• recurrent cough
• sudden onset breathlessness at rest

Question 6

Define the investigations used to diagnose asthma

Answer 6

• spirometry of FEV1/FVC ratio (less than 70%)
• lung volume by gas trapping (increased)
• CO transfer (alveolar function)
• response to bronchodilator
• response to oral corticosteroids
• peak flows
• response to methacholine
• exhaled nitric oxide

Question 7

Explain how to assess the severity of acute, severe asthma

Answer 7

• ability to speak in full sentences
• PEFR
• respiratory rate
• arterial blood gases
• no need for pulsus paradoxus
• all will be increased/more sever in acute severe asthma

Question 8

Define the role of patient education in the management of asthma

Answer 8

• understand about the chronic nature of asthma and need for a long-term care approach
• what happens during acute attacks and where medications act
• skills to monitor asthma including use of peak flow meter and use of inhalation devices - learning about warning signs
• plan to manage acute attack at home
• active participation.
• identify asthma triggers
• when to come for follow-up and what would be discussed next time

Question 9

Outline the stepwise approach to management of asthma based on the National British Thoracic Society Guidelines

Answer 9

• avoid triggers
• mild relieving medication
• increase dose
• preventer therapy with dose of ICS
• add on therapy e.g. long-lasting beta-2 agonists
• high dose therapy
• oral steroids (tablets)
• immunotherapy
• bronchial thermoplasty

Question 10

Describe the clinical management of acute, life-threatening asthma

Answer 10

in the home and work;

• oxygen and resuscitation equipment
• nebulised beta-2 agonists
• self-injectable adrenaline
• prednisolone tablets
• hospital attendance upon wheeze development