Asthma Clinical Features in Adults 2

Question 1

What can a spirometer be used to measure

Answer 1

How much air can be expelled

Question 2

Are the spirometery results reproduceable

Answer 2

Yes

Question 3

Will a spirometer exclude asthma

Answer 3

No

Question 4

What do FEV1 levels measure

Answer 4

Airway diameter

Question 5

What does the FVC measure

Answer 5

Lung volume and can identify changes in lung tissue

Question 6

What are the FEV1 and FVC levels like in asthma

Answer 6

Normal

Question 7

What should be done if spirometery is normal

Answer 7

Peak flow monitoring

Bronchial provocation with nitric oxide

Question 8

What should be done if the spirometery shows obstructed disease

Answer 8

Full pulmonary function test

Question 9

How can the reversibility of an obstructed disease be tested

Answer 9

Through the use of a beta 2 agonist or steriods

Question 10

What does it mean if the FEV1/FVC is below 70% and FEV1 is below 80% predicted

Answer 10

Obstructed disease

Question 11

What will the full pulmonary testing effectively exclude

Answer 11

COPD

Emphysema

Question 12

What does gas trapping measure and what is used

Answer 12

Helium dilution to measure lung volumes

Question 13

What will the results of gas trapping show in obstructed disease

Answer 13

The residual volume increases
The total lung capacity increases
RV/TLC is over 30%

Question 14

Will gas transfer be normal or abnormal in asthma

Answer 14

Normal

Question 15

How can gas transfer be measured

Answer 15

Carbon monoxide gas transfer

Question 16

What to tests are used in full pulmonary function testing

Answer 16

Gas trapping

Gas transfer

Question 17

When should the response to the bronchodilator be at the baseline

Answer 17

15 minutes post 400 microgram inhaled salbutamol

15 minutes post nebuliser 2.5-5mg salbutamol

Question 18

Which results show that significant reversibility is possible

Answer 18

If delta-FEV1 is over 200ml and delta-FEV1 is over 15% of the baseline

Question 19

When is the use of oral corticosteriods useful

Answer 19

In obstructed disease - it will help determine reversibility and variability

Question 20

What 2 diseases can oral corticosteriods seperate

Answer 20

COPD from asthma

Question 21

Why should the variability in airflow obstruction be looked for in asthmatic patients

Answer 21

Their lung function may be normal in clinic

Question 22

How can the variability in airflow obstruction be identified

Answer 22

Through the use of a peak flow meter and chart twice daily for 2 weeks

Question 23

What may the results of a peak flow meter for asthmatic patients show

Answer 23

Morning/nocturnal dips
Decline over weeks/days
Variability over 20% ([highest-lowest]/highest)

Question 24

What 2 things can cause occupational asthma to be suspected

Answer 24

Work related symptoms

Working with recognised sensitisers

Question 25

How is occupational asthma diagnosed

Answer 25

From serial peak flow readings that are done every 2 hours for a minimum of 5 days Must be at least 2 pairs of exposed/unexposed periods Antibodies and bronchial challenges can also confirm this

Question 26

Name an optional investigation which can be conducted

Answer 26

Testing of the airway responsiveness to methacholine/histamine/mannitol/exercise

Question 27

What other tests can be useful in identifying asthma

Answer 27

Chest X-ray - may show hyperinflation and hyperlucent Skin prick testing - identifies atopic status Total and specific IgE - identifies atopic status Full blood count - may show eosinophilia (atopy)

Question 28

What are the 5 main things that should be tested in life threatening asthma

Answer 28

``` Ability to speak Heart rate Respiratory rate PEF Oxygen saturation/Arterial blood gases ```

Question 29

Should a pulsus paradoxus be conducted in life threatening asthma

Answer 29

No

Question 30

How will moderate asthma present

Answer 30

``` Able to speak complete sentences HR <110 RR <25 PEF 50 - 75% predicted or best SaO2 > 92% (no need for ABG) PaO2 > 8kPa ```

Question 31

How will severe asthma present

Answer 31

``` Unable to speak, unable to complete sentences HR >110 RR >25 PEF 33 - 50% predicted or best SaO2 > 92% PaO2 > 8kPa ```

Question 32

How will life threatening asthma present

Answer 32

``` Grunting Impaired consciousness, confusion, exhaustion HR >130, or bradycardic Hypoventilating PEF < 33% predicted or best Cyanosis SaO2 < 92% PaO2 < 8kPa PaCO2 normal (4.6 - 6.0kPa) ```

Question 33

How will near fatal asthma present

Answer 33

Raised PaCO2