Asthma

Question 1

Asthma

Define it’s pathology

Answer 1

13. Asthma is an obstructive disease characterized by cellular infiltration and localized inflammation of the airways causing increased airway resistance. Can be atopic or non-atopic. Atopic asthma results in sensitivity to allergens and raised levels of IgE, which promotes a strong inflammatory response.
    Non-atopic asthma does not have raised IgE levels or sensitivity to allergens, and is a mismatch between the drives of PNS and SNS.

Question 2

Clinical features of asthma?

Answer 2

• Chest tightness
• WOB
• Breathlessness
• Wheeze
• Cough
• Lung hyperinflation
• Hypoventilation
• Decreased exercise tolerance

Question 3

What reductions in intra-luminar diameter are associated with asthma?

Answer 3

Bronchospasm/ Bronchoconstriction
Mucosal oedema
Sputum 
•  Produce very little sputum 
•  Spiral shaped, sticky, difficult to expectorate. 
•  Curshmann’s spiral. 

Chronic inflammation - Airway remodelling.
• Hypertrophy of smooth muscles
• Increase airway resistance!
• Thickening of basement membrane
• Hyperplasia of mucuous glands (more sputum!)
• Continuing cellular infiltration

Question 4

What are clincal investigations for asthma, and what would you expect to see?

Answer 4

ABG - High PaCO2 and low PaO2 during attack
Auscultation - Wheeze on expiration, reduced breath sounds in emergency.
Spirometry - Lowered FEV1/FVC ratio
CXR - Hyperinflation - Large black lung fields, horizontal fibs, vertical heart, increased diaphragm angles.

Question 5

Drugs for asthma?

Answer 5

SABA - Short acting beta agonist (adrenergic).
Salbutomol and terbuline. Work by activating sympathetic receptors to cause bronchodilation.

SAMA - Short acting muscarinic antagonist (cholinergic). Slow acting. Tiotropium or Ipatropium bromide. Works by suppressing parasympathetic receptors, causing bronchodilation

Disease Modification - Or, can we get to the root cause and treat symptoms?
Cytokine inhibitor - Montelukast
Corticosteroid - Prednisone

Question 6

Physiotherapy management

Answer 6

Positioning of Ease - High slide lying
ACBT - BC, may progress if productive
Adjuct: IPPB ( the Bird!) 
Relaxation techniques
Exercise progression