Asthma

Question 1

What is asthma?

Answer 1

Asthma is a chronic inflammatory condition of the airways which causes episodic exacerbations of bronchoconstriction

Question 2

What is bronchoconstriction?

Answer 2

When the smooth muscles of the airways (the bronchi) contract causing the diameter of the airways to reduce

Question 3

What does narrowing of the airways cause?

Answer 3

An obstruction to airflow in and out of the lungs

Question 4

Is asthma a reversible or irreversible airway obstruction?

Answer 4

Reversible airway obstruction

Question 5

What causes the bronchoconstriction in asthma?

Answer 5

Caused by airway hypersensitivity
can be triggered by environmental factors
typically respond to bronchodilators e.g. salbutamol

Question 6

What are the typical triggers of asthma

Answer 6

Night time or early morning 
Infection
Cold, damp or dusty air 
Exercise 
Animals
Strong emotions

Question 7

Typical presentation of asthma

Answer 7

Episodic symptoms
Diurnal variation often worse at night
Dry cough with wheeze and shortness of breath
History of other atopic conditions - eczema, hayfever and food allergies
FHx
Bilateral widespread “polyphonic wheeze” heard by a healthcare professional

Question 8

Presentation indicating a diagnosis other than asthma

Answer 8

Wheeze associated with coughs and colds suggests viral induced wheeze
Isolated or productive cough
Normal investigations
No response to treatment
Unilateral wheeze, This suggests a focal lesion or infection

Question 9

What are the BTS guidelines on diagnosis of asthma?

Answer 9

High probability of asthma clinically. Try treatment
Intermediate probability of asthma: Perform spirometry with reversibility testing
Low probability of asthma: Consider referral and investigating other causes

Question 10

What are NICE guidelines on diagnosis?

Answer 10

NICE recommends assessment and testing at a diagnostic hub to establish a diagnosis.
They specifically advise not to make a diagnosis clinically and require investigations

Question 11

What are the first line investigations for asthma?

Answer 11

Fractional inhaled nitric oxide

Spirometry with bronchodilator reversibility

Question 12

What are the next steps if there is diagnostic uncertainty following first line investigations?

Answer 12

Follow up with further testing:
Peak flow variability - diary of peak flow measurements several times per day for 2-4 weeks
Direct bronchial challenge test with histamine or methacholine

Question 13

What are the forms of long term management?

Answer 13

Short acting beta 2 agonist