9. Asthma

Question 1

What is asthma?

Answer 1

Recurrent episodes of dyspnoea characterised by cough wheeze and reversible airway obstruction

Question 2

Explain the psychophysiology of asthma?

Answer 2

bronchial muscle contraction- due to stimulation

Mucosal swelling/inflammation- mast cell and basophil degranualtion

increased mucous prodcution

Question 3

What may exacerbate asthma?

Answer 3

Cold air, exercise, emotion, allergens (dust mites, pollens, fur, infection, smoking, passive smoking)

pollution, NSAIDS, B blockers

Question 4

What other conditions/symptoms may be associated with asthma?

Answer 4

Disturbed sleep
Acid reflux
Other atopic disease- eczema, hay fever, allegy, FH

Question 5

What jobs are associated with asthma?

Answer 5

Pain sprayers
Food processors
Welders
Animal handlers

Question 6

Describe the difference between a severe and life threatening asthma attack?

Answer 6

Severe- can t complete sentences, pulse >110bpm, RR>25, PEF 30-50% predicted

Life threatening- silent chest, cyanosis, confusion, sats<92, paO2<8kPa, bradycardia, PEF<33%

Question 7

What investigations are done in an acute asthma attac?

Answer 7

PEF, sputum culture, FBC, U&E

CRP, Blood cultures, ABG

Question 8

What does an ABG tell you about an asthma attack

Answer 8

reduced PaO2 and reduced PaCO2 (hyperventilation)- normal

Normal PaO2, PaCO2- reduced/normal- taken too early

Reduced paO2, increased/normal PaCO2- respiratory failure imminent- ITU and chest X-ray for pneumothorax/infection

Question 9

How do you diagnose asthma?

Answer 9

Clincial diagnosis comprised of a wheezing patient
Symtpoms that fit the picture (spirometery<0.8),
Peak flow monitoring over 2 weeks, 3 times a day. may be morning dips
Reversibility when treated (15% on spirometery)

Question 10

What lifestyle measures can help those with asthma?

Answer 10

Help to quit smoking
Avoid triggers
Inhaler technique
Action plan of what to do when attack
Papworth breathing method

Question 11

Describe the step up/step down treatment of asthma

Answer 11

Initial prescription of SABA and inhaled low dose corticosteroids

Add inhaled LABA

Consider increasing ICS dose or add LTRA. If no reaction to LABA stop LABA

Refer to specialist

Question 12

What is paramount to monitor when moving a patient onto more therapies?

Answer 12

Monitor inhaler technique- may be a big cause of someone’s asthma not being controlled properly

Question 13

Explain the method of action of a short acting beta agonist (SABA)

Give some examples

Answer 13

Act on beta 2 receptors to relax bronchial smooth muscle, acting within minutes. Side effects include tachyarrythmias, reduced potassium, tremor

Question 14

Explain the method of action of a long acting beta agonsit (LABA)

Give some examples

Answer 14

Act by the same method bu tlast for much longer. May reduce nocturnal symptoms and reduce morning dips in peak flow

Salmeterol, formoterol

Question 15

Describe the effects of corticosteroids

Give some examples

Answer 15

Reduces bronchial mucosal inhalation over the course of a few days. Typically inhaled to reduce systemic side effects.

Beclamethasone, budesonide

Question 16

Describe the effects of leukotriene receptors?

Give some examples?

Answer 16

Blocks the effects of cysteinyl leukotirenes in the airway therefore reducing mucousal inflammation

Ipratropium, tiotropium