Asthma

Question 1

Asthma Hx points

Answer 1

Precipitants 
maternal factors 
Diurnal variation 
Exercise 
Sleep disturbance 
Acid reflux 
Other atopic diseases 
Job exposure
Salbutamol reversibility

Question 2

Examination

Answer 2

Tachypnoea with wheeze

Hyperinflated chest with hyper resonant chest
diminished air entry
longer expiration than inspiration

Question 3

Differential Diagnosis for Asthma

Answer 3

COPD 
Airway obstruction 
Pneumothorax or PE 
Bronchiectasis 
Foreign body aspiration

Question 4

Investigations for asthma

Answer 4

ACUTE:
Bloods: FBC, UEC, CRP, Cultures, ABG
Peak Flow
Sputum culture
CXR

CHRONIC:
PEF monitoring
Spirometry - obstructive with > 15% reversible
CXR
RAST Testing - skin prick allergy testing

Question 5

Asthma Non-Pharm management

Answer 5

Smoking cessation 
Avoidance of precipitants 
Twice daily PEF
Written emergency plan
Checking inhaler technique and using a spacer - ensuring that for old people they are able to properly push the MDIs

Question 6

Asthma Pharmacological treatment

Answer 6

MART Therapy = Maintenance and Reliever Therapy
Reliever = salbutamol inhaler
Maintenance = LABA + ICS = Budesonide/formoterol

for hard to manage:

• Leukotrine receptor antagonist
• oral prednisone
• Tiotropium

Question 7

ACUTE asthma

Answer 7

Nebulized salbutamol
Oxygen
Hydrocortisone or prednisolone
(If needed: Ipratropium nebs and Mag sulf)

Question 8

Side Effects of Asthma Treatment

Answer 8

Budesonide - headache, dizziness, nausea, abd pain
Salbutamol - headache, shake, nervousness
All have a similar SE profile

Question 9

SABA?

Answer 9

Salbutamol - ventolin/respigen

Question 10

LABA?

Answer 10

Salmeterol - serevent

Question 11

SAMA

Answer 11

Ipratropium Bromide - Atrovent

Question 12

LAMA

Answer 12

tiotropium bromide - spiriva

Question 13

low potency ICS

Answer 13

fluticosone propionate - flixotide

beclomethosone - QVAR

Question 14

Combination therapies

Answer 14

SABA + Antichol = duolin

LABA + ICS = seritide and symbicort