Asthma

Question 1

Asthma

Answer 1

obstructive chronic inflammatory disorder of the airways

Question 2

RF

Answer 2

atopy
FH
exposure to chemicals/dust
obesity
smoking

Question 3

signs

Answer 3

wheeze
cough
chest tightness
nocturnal wheeze/cough

Question 4

investigations

Answer 4

spirometry

reversibility test with treatment

Question 5

spirometry

Answer 5

can do it upright/standing
measure three times and record the best one

FVC - forced vital capacity is measured
FEV1 - forced expiratory volume in 1 sec

same FVC/FEV1 - restrictive disorder (>0.7)
reduced - obstructive (<0.7)

Question 6

management

Answer 6

1. SABA
2. SABA + low dose ICS
3. SABA + low dose ICS +LKTA
4. SABA + low dose ICS + LABA (+/- LKTA)
5. SABA + MART
6. SABA + increased MART/LABA + increased ICS
7. specialist

life style factors

Question 7

what drugs cause problems for patients with asthma

Answer 7

aspirin

beta blockers

Question 8

asthma attacks

Answer 8

moderate:
able to talk
PEF - 50-70%

severe:
PEF - 33-50%
use of accessory muscles
not able to speak
low PaCO2
relatively normal PaO2

life threatening:
Cyanosis
Hypotension
Exhaustion
Silent chest
Tiring
PEF < 33%
normal PCO2
Oxygen levels <90%

near fatal:
PaCO2 raised

Question 9

management of moderate attack

Answer 9

steroid

oral prednisolone

Question 10

management of severe/life-threatening/near fatal

Answer 10

ABGs to find PaO2 and PaCO2 levels

oxygen mask
nebuliser salbutamol
prednisolone
IV steroids

if still not effective:
IV magnesium sulphate
refer to ICU
aminophilline

Question 11

when can you discharge a patient

Answer 11

when they are stable on normal regime therapy for at least 24hrs

Question 12

what is involved in a MART

Answer 12

ICS and LABA

Question 13

what criteria is needed to give SABA and low dose ICS as a first line

Answer 13

symptoms occurring >3 times

nocturnal coughing