Respiratory: Asthma

Question 1

What is asthma?

Answer 1

A chronic inflammatory disorder of the airways resulting in reversible airway obstruction - inflammation, bronchoconstriction and mucus

Question 2

What is the consequence of repetitive episodes of asthma?

Answer 2

The airway undergoes remodelling, there is damaged epithelium and increased smooth muscle thickness

Question 3

What are some allergens that can trigger asthma?

Answer 3

Indoor allergens: pets, dust mites, mould
Outdoor allergens: pollens, tobacco smoke, pollutants
Others: Cold air, exercise, medications such as NSAIDs and beta blockers

Question 4

What are some of the signs and symptoms of asthma?

Answer 4

Recurrent wheeze, breathlessness, chest tightness
Cough - dry, worse at night, exercise induced
Variable airflow obstruction

Question 5

What is a wheeze?

Answer 5

A high pitched, expiratory musical sound from narrowed airways (compression or obstruction)

Question 6

How can you assess difficulty in breathing?

Answer 6

In adults - measure RR and look for accessory muscle use
In children - recession of the IC muscles, nasal flaring, tracheal tug (because in children the skin and tissues are more pliable)

Question 7

What is atopy?

Answer 7

A genetic tendency to develop allergies eg eczema, hayfever, allergies and asthma all grouped together
So look for these in PMH

Question 8

What is the gold standard of diagnosis of asthma?

Answer 8

Spirometry however due to long waiting lists, it is more practical to give a months trial of bronchodilators and measure peak flows. If they help then continue to treat as asthma

Question 9

How can you help pts to prevent asthma exacerbations?

Answer 9

Change bedding, pillows etc every few years
Get fresh air
Stop smoking

Question 10

What is a short acting beta agonist?

Answer 10

Salbutamol inhaler (use with a spacer in children)
If used more than 3x a week or there are nocturnal symptoms eg coughing or wheezing more than once a week need a preventer inhaler

Question 11

What does the brown preventer inhaler do?

Answer 11

Contains a steroid to inhibit inflammatory cells and mediators.
Aims to prevent attacks rather than treat attacks

Question 12

What is a long acting beta agonist?

Answer 12

Salmeterol inhaler

Has a slower onset of action so not used for acute asthma attacks

Question 13

How would you treat a severe asthma attack?

Answer 13

• give oxygen
• give salbutamol and atrovent nebulisers back to back
• get IV access in case you need to give IV salbutamol
• be prepared to intubate and admit to ITU

Question 14

What is the nature of the airflow obstruction in asthma\?

Answer 14

Restrictive