asthma

Question 1

what is asthma?

Answer 1

• Is a chronic inflammatorydisorder of the airways

* inflammation is associated with bronchial hyper-reactivity

Question 2

pathophysiology of asthma

Answer 2

• Increase in bronchial smooth muscle

* Loss of normal bronchial elasticity

Question 3

presentation of asthma

Answer 3

Early onset, classical wheezing and often a trigger, chest tightness, shortness of breath

Question 4

asthma: aspirin and NSAIDS

Answer 4

may trigger bronchospasm and rhinitis

Question 5

diagnosis of asthma

Answer 5

Spirometry measures Lung Volumes/Pulmonary Functions

Question 6

aims of asthma treatment

Answer 6

–Enable normal activity
–Promote normal lung function
–Reduce day to day symptoms
–Prevent reduce acute attacks/exacerbations
–Minimise adverse effects of treatment
–Meet patient / carer expectations

Question 7

shorting acting beta agonist SABA

e.g. Salbutamol, terbutaline

Answer 7

bronchodilators . They relax the muscles lining the airways that carry air to the lungs (bronchial tubes)

Question 8

Long-acting beta-agonist: LABA

e.g. Formoterol, salmeterol, vilanterol

Answer 8

relax airway smooth muscle by stimulating β2-adrenergic receptors.

Question 9

Inhaled Corticosteroid: ICS

e.g. Budesonide, Fluticasone (propionate or furoate)

Answer 9

suppress inflammation mainly by switching off multiple activated inflammatory genes through reversing histone acetylation via the recruitment of histone deacetylase 2 (HDAC2)

Question 10

Leukotriene receptor antagonist: LTRA

e.g. Montelukast

Answer 10

It works by blocking the action of leukotriene D4 in the lungs resulting in decreased inflammation and relaxation of smooth muscle.

Question 11

SAMAs-Short Acting Muscarinic Antagonists

Ipratropium

Answer 11

cause bronchodilation by blocking the bronchoconstrictor effect of acetylcholine on muscarinic receptors in airway smooth muscle.

Question 12

LAMA- Long Acting Muscarinic Antagonists (Tiotropium)

Answer 12

by competitively blocking the cholinergic response manifested by acetylcholine (ACh)

Question 13

Cromones

Nedocromil Sodium

Answer 13

Inhibit early and late stage responses to allergens

Fallen from favour in recent years

Question 14

Theophyllines

Answer 14

smooth muscle relaxation (i.e., bronchodilation) and suppression of the response of the airways to stimuli (i.e., non-bronchodilator prophylactic effects).

Question 15

asthma treatment depends on

Answer 15

• Frequency of symptoms
• Severity / impact of symptoms
• History of flare-ups

Question 16

starting treatment for adults

Answer 16

•ICS regularly (preventer)
PLUS
•SABA prn (reliever)

Question 17

LABAs for children

Answer 17

not recommended

rountinely used at step 3 for children

A LTRA is more likely to be appropriate in younger patients

Question 18

before stepping up

Answer 18

• Check symptoms are due to asthma
• Check inhaler technique is correct
• Check adherence and persistence with treatment
• Consider modifiable risk factors e.g. smoke exposure

Question 19

ICS use requires

Answer 19

–Oro-pharyngeal deposition increases risk of sore mouth, oral candidiasis and hoarse voice
–Rinsing mouth after use
–Clean teeth after use
–Attending for review important

can cause
–adrenal suppression
–osteoporosis