Asthma clinical lecture

Question 1

Co-factors of asthma?

Answer 1

Upper airway disease - sinus, polyps, rhinitis, sinusitis
GORD
Obesity
Smoking
Exposures - cigarettes, workplace, infection
Allergies/aero-allergens - pets, pollen, aspergillus, HDM

U-GO-SEA

Question 2

Tools for diagnosis

Answer 2

History and exam
Peak flow diary - absolute values, variability, early morning dips
Spirometry - obstruction (FEV/FVC <0.7), FEV% predicted
Bronchial provocation tests - mannitol, methacholine (PD20)
FeNO - 25/50ppb
CXR, bloods (eosinophils, IgE, aspergillus), Ct thorax, bronchoscopy

Question 3

FeNO

Answer 3

Exhaled NO
Eosinophilic/allergic inflammation
Th2 (IL4,5,13)

Question 4

What are the different asthma phenotypes?

Answer 4

Allergic, non-allergic, late-onset, fixed airflow obstruction, asthma with obesity

Question 5

What are endotypes?

Answer 5

Presumed biological pathways, pathophysiology, biomarkers

Question 6

What is the idea of stratified medicine for asthma?

Answer 6

Treatment tailored to patient’s phenotypes and endotypes - bespoke
Use of smart inhalers, breath analytics