Asthma And COPD

Question 1

What is asthma ?

Answer 1

An inflammatory disorder of the conducting airways. The airways become hyper - responsive and constrict easily in response to a wide range of exogenous and endogenous stimuli.

Question 2

What are some types of asthma ?

Answer 2

Allergic asthma
Non-allergic asthma
Late onset asthma
Asthma with fixed airflow limitations
Asthma with obesity

Question 3

What are some features of allergic asthma ?

Answer 3

Most easily recognised type
Majority begins at childhood
Associated with a family history of eczema, allergic rhinitis or food and drug allergy
Usually respond well to inhaled corticosteroids

Question 4

What are some features of non-allergic rhinitis ?

Answer 4

Not associated with allergy
Sputum contains neutrophils, eosinophils and only a few inflammatory cells
Often respond less well to ICS

Question 5

What are some features of late onset asthma ?

Answer 5

Onset is in adult life particularly in women
Tends to be non allergic
Higher dose of ICS often required

Question 6

What are some features of asthma with fixed airflow limitations ?

Answer 6

Seen in patients with long standing asthma
Thought to be caused by airway remodelling

Question 7

What are some features of asthma with obesity ?

Answer 7

Some obese asthmatic people suffer with prominent respiratory symptoms with little eosinophilic airway inflammation

Question 8

What is the pathogenesis of atopic asthma ?

Answer 8

Airway inflammation caused by exposure to an environmental allergen. This occurs by IgE binding to bronchial mast cells resulting in degranulation and the release of pro-inflammatory mediators.

Question 9

What are the 2 phases of inflammation ?

Answer 9

Acute phase
Delayed phase

Question 10

What are the results of inflammation in asthma ?

Answer 10

Bronchial hyper-reactivity
Symptoms of cough, wheeze and chest tightness
Signs of variable polyphonic wheeze

Question 11

What are some common environmental allergens in atopic asthma ?

Answer 11

Faeces of house dust mite
Cat salivary antigens
Pollen
Fungal spores
Grain antigens
Rat antigens

Question 12

What occurs in the acute inflammatory response in asthma ?

Answer 12

It is characterised by bronchoconstriction and airway oedema. This begins within minutes of allergen exposure and resolves within hours. Cross linking of mast cell bound IgE allergen results in degranulation and the release of :
. Histamine
. Protease
. Tissue necrosis factor
. Platelet activating factor

Question 13

What occurs in the delayed inflammatory response ?

Answer 13

The pro - inflammatory mediators such as interleukin-5 released by mast cells recruit, basophils and TH2-lymphocytes.
This results in :
. Ongoing inflammation
. Sensitisation of sensory nerve endings resulting in bronchial hyper-responsiveness

Question 14

What are some risk factors for asthma ?

Answer 14

Host factors - genetics, obesity and sex
Infections
Having allergens
Diet
Stress
Exposure to tobacco smoke

Question 15

What are some clinical factors of asthma ?

Answer 15

Wheezing
SOB
Chest tightness
Cough ( +/- sputum )
Worsening at night or in the early morning
Symptoms are triggered by a viral infection, exercise, allergen exposure or changes in the weather.
Follow a diurnal pattern

Question 16

What are some features of a severe attack of asthma ?

Answer 16

Difficulty in speaking
Tachypnoeic and breathless
Tachycardia
Pulses paradoxus
Silent chest
Drowsiness
Cyanosis

Question 17

What type of resp failure is a severe asthma attack ?

Answer 17

Type 2 resp failure

Question 18

What are some differentials of asthma ?

Answer 18

URTI
Bronchiectasis
Cystic fibrosis
Hyperventilation
COPD
PE

Question 19

What are some investigations to do when suspecting asthma ?

Answer 19

FeNo testing
Spirometry
Peak expiratory flow

Question 20

What is the stepwise management for asthma ?

Answer 20

Step 1 - SABA PRN
Step 2 - low dose ICS
Step 3 - low dose ICS + LABA
Step 4 - medium dose ICS + LABA
Step 5 - high dose ICS + LABA
Consult an asthma specialist after step4

Question 21

What is ‘complete control’ of asthma ?

Answer 21

No daytime symptoms
No night time waking due to asthma
No need for rescue medication
No asthma attacks
No limitation on physical activity
Normal lung function

Question 22

What medication is given as an intermittent reliever for asthma ?

Answer 22

Prescribe an inhaled SABA for all patients with symptomatic asthma

Question 23

What is given as a regular preventer for asthma ?

Answer 23

Inhaled ICS are recommended initially given twice daily

Question 24

Other than ICS what are some other medications used as controllers in asthma ?

Answer 24

Leukotriene antagonists
Methotrexate
LABA in combination with inhaled glucocorticosteroids

Question 25

What are some medications given as relievers in asthma care ?

Answer 25

SABA Short acting theophylline Inhaled Anticholinergics

Question 26

Why are controllers given in asthma patients ?

Answer 26

To control clinical symptoms and reduce future risks such as exacerbations and decline in lung function

Question 27

What is the aim of relievers for asthma patients ?

Answer 27

To reverse bronchoconstriction and relieve the symptoms quickly

Question 28

When should a person with asthma be admitted to hospital ?

Answer 28

Any features of life threatening or near fatal asthma attack

Question 29

What is the treatment of acute asthma in adults ?

Answer 29

Oxygen High dose SABA Ipratropium bromide Prednisolone

Question 30

What factors should be monitored and recorded in primary care for an asthmatic patient ?

Answer 30

Symptomatic control Lung function assessed by spirometry or peak flow Any exacerbations Inhaler technique Adherence Bronchodilator reliance

Question 31

What is COPD ?

Answer 31

A condition characterised by airflow obstruction which is progressive not fully reversible and does not change markedly over several months.

Question 32

What are some causes of COPD ?

Answer 32

Smoking Indoor air pollution Occupational exposure to toxins Outdoor air pollution Genetic factors Infections

Question 33

What are some pathological changes seen in COPD ?

Answer 33

Chronic inflammation - increased numbers of specific inflammatory cell types in different parts of the lung Structural changes due to repeated injury Mucous hypersecretion Ciliary dysfunction Airflow limitation and hyperinflation / air trapping

Question 34

What are some clinical features of COPD ?

Answer 34

Chronic and progressive dyspnoea Chronic cough Regular sputum production Wheezing Chest tightness Fatigue Weight loss ( severe COPD )

Question 35

What are some signs of COPD ?

Answer 35

Hyper inflated chest Wheeze Purse lip breathing Use of accessory muscles Peripheral oedema Raised JVP

Question 36

What are some investigations you should perform when suspecting COPD ?

Answer 36

Spirometry CXR FBC Sputum culture if present

Question 37

What are some differentials of COPD ?

Answer 37

Asthma Bronchiectasis Congestive HF Carcinoma of the bronchi

Question 38

What is the goals of management of COPD ?

Answer 38

Reduce long term lung function decline Prevent and treat exacerbations Reduce hospitalisations and mortality Relieve dyspnoea Improve exercise tolerance Prevent and treat complications

Question 39

What are some non-pharmacological management options for COPD ?

Answer 39

Smoking cessation Recommend physical activity Pulmonary rehabilitation Up to date vaccinations

Question 40

What is the pharmacological management of COPD ?

Answer 40

Bronchodilators - - SABA - LABA - Anti-muscarinics Anti-inflammatory - - ICS - Oral glucocorticoids - mucolytics

Question 41

What is the follow up of COPD in primary care ?

Answer 41

Should be reviewed annually or more frequently if required

Question 42

What should be covered in a routine follow up of COPD ?

Answer 42

Smoking status Symptom control Presence of complications Inhaler technique

Question 43

What are some complications of COPD ?

Answer 43

Respiratory failure Pulmonary artery hypertension Cor pulmonale Pneumothorax Weight loss

Question 44

What palliative care can be given in end stage COPD ?

Answer 44

Treatment for dyspnoea - opiates, morphine, oxygen , pulmonary rehab Nutritional support