asthma in adults

Question 1

what is asthma

Answer 1

chronic inflammatory condition of airways that causes episodic exacerbations of bronchoconstriction

Question 2

bronchoconstriction

Answer 2

smooth muscle of airways contract causing reduction in the diameter of airways

narrowing of airways causes an obstruction to airflow going in and out of lungs

Question 3

characteristic of asthma

Answer 3

reversible airway obstruction that responds to bronchodilators e.g. salbutamol

Question 4

what causes bronchoconstriction in asthma

Answer 4

hypersensitivity of airways and can be triggered by environmental factors

Question 5

typical triggers

Answer 5

infection,
night time/early morning, 
exercise,
animals ,
cold/damp ,
dust,
strong emotions

Question 6

features indicative of asthme

Answer 6

• episodic symptoms
• diurnal variability (worse at night)
• dry cough, wheeze and SOB
• Hx atopy
• FHx
• bilateral widespread polyphonic wheeze

Question 7

features NOT indicative of asthma

Answer 7

• wheeze relating to coughs and cold = VIW
• isolated/productive cough
• normal Ix
• no response to Rx
• unilateral wheeze

Question 8

BTS/SIGN guidelines on diagnosis: high probability of asthma

Answer 8

try treatment

Question 9

BTS/SIGN guidelines on diagnosis: intermediate probability of asthma

Answer 9

perform spirometry with reversibility testing

Question 10

BTS/SIGN guidelines on diagnosis: low probability of asthma

Answer 10

consider referral and invesigating for other causes

Question 11

NICE guidelines on asthma diagnosis

Answer 11

assessment and testing to establish diagnosis

not to make clinical diagnoses and need tests

Question 12

NICE 1st line Ix

Answer 12

fractional exhaled nitric oxide

spirometry with bronchodilator reversibility

Question 13

NICE: further testing if uncertainty after 1st line tests

Answer 13

peak flow variability

direct bronchial challenge test with histamine or methacholine

Question 14

SABA

Answer 14

reliever/rescue medication

adrenaline acts to relax smooth muscle, so bronchioles dilate

Question 15

inhaled corticosteroids

Answer 15

preventer medication

reduce inflammation and reactivity of airways

Question 16

LABA (long acting beta 2 agonists)

Answer 16

work in same way as SABA but with longer lasting effects

Question 17

long acting muscarinic antagonists (LAMA)

Answer 17

block acetylcholine receptors –> bronchodilation

Question 18

leukotriene receptor antagonists

Answer 18

leukotrines are produced by immune system –> inflammation, bronchoconstriction, mucus secretion

LTRAs block leukotreine effects

Question 19

theophylline

Answer 19

relaxes bronchial smooth muscle and reduces inflammation

monitoring of plasma level is required

Question 20

maintenance and reliever therapy (MART)

Answer 20

combination inhaler containing low dose ICS and fact acting LABA

Question 21

Mx: BTS/SIGN stepwise ladder

Answer 21

1. SABA
2. • ICS
3. • LABA
4. consider LTRA, oral salbutamol. oral theophyline or LAMA
5. high dose ICS
6. oral steroids

Question 22

Mx: NICE guidelines

Answer 22

1. SABA
2. • ICS
3. • LTRA
4. • LABA
5. consider switching to MART
6. moderate dose ICS
7. high dose ICS or oral theophyline or LAMA