asthma

Question 1

how to ask asthma control

Question 2

patient’s asthma counselling

Answer 2

• Reassess inhaler technique
• importance adherence to tx
• stop smoking, avoid trigger
• pneumococcal and annual influenza vaccine

Question 3

rf poor asthma outcomes

Answer 3

1. POOR ASTHMA SYMPTOM CONTROL!
2. High inhaler use — defined as >1 (200mg) Inhaler canister use per month
3. High risk comorbidities, including: Obesity, Pregnancy, GERD, Chronic Rhinosinusitis, Confirmed food allergies
4. Persistent exposures to Environmental Triggers: Tobacco smoke, Air pollution
5. Low Socioeconomic status
6. Blood Eosinophillia or Raised FeNO3
7. Independent risk factors:
   
   • Ever Intubated for life threatening asthma exacerbation
   • ICU admission
   • ≥1 Severe exacerbations in the past 1 year

Question 4

SE asthma medication (systemic and local)

Answer 4

1. Systemic (high dose ICS)
   
   • easy bruising
   • earlier osteoporosis
   • cataracts
   • glaucoma
2. Local
   
   • oral thrush
   • dysphonia

Question 5

asthma definition (gina 2020)

Answer 5

Asthma is a heterogeneous disease,
usually characterized by chronic airway inflammation.
It is defined by the history of respiratory symptoms such as wheeze, shortness of breath, chest tightness and cough
that vary over time and in intensity,
together with variable expiratory airflow limitation.

Question 6

hygiene hypothesis

Answer 6

Those who grew up in a clean environment predisposes them to Ig E response to allergens

👉🏼 Children who are exposed to “dirty” environments develop immune tolerances towards harmless allergen particles such as: Dust, bed mites, pollen etc

Question 7

IgE function

Question 8

asthma triggers

Question 9

patterns increasing and decreasing probability of asthma

Question 10

features of severe attack and life threatening asthma attack

Answer 10

Severe attack

1. Inability to complete sentences in 1 breath
2. Pulse > 120bpm (GINA)
3. RR > 30bpm (GINA)
4. PEF 33–50% predicted

Life-threatening attack

1. Silent chest
2. confusion / coma
3. exhaustion
4. cyanosis
   
   • PaO₂<8kPa (80mmHg)
   • PaCO₂ 4.6–6.0kPa (35-45mmHg)
     if >6 kPa → near fatal dt failing respi effort → ventilate the pt
   • SpO₂ <92%
5. bradycardia / hypoTN / arrhythmia
6. PEF <33% predicted

Question 11

preferred controller and reliever in step 1 & 2

Question 12

preferred controller in step 3, 4, 5

Question 13

3 factors contributing to bronchial narrowing

Question 14

atopy assc w asthma

Answer 14

eczema, allergic rhinitis, FHx of allergies

Question 15

ix asthma acute attack

Answer 15

1. Bedside - PEF
2. Sputum culture
3. ABG - ↓PaO₂ ↓PaCO₂ (hyperventilation) — Respiratory AlkalosisIf PaCO₂ normalising / ↑, admit ICU for ventilation as respi effort failing
4. FBC
5. U&E — Excessive use of β2 agonist will cause hypokalemia!
6. CRP
7. Blood cultures

Question 16

ix chronic asthma

Answer 16

Chronic asthma:

1. Lung function test - spirometry ⇒ FEV1/FVC < 0.7 obstructive
   
   • Positive bronchodilator (BD) reversibility
   • in order to confirm dx if not yet
2. CXR - hyperinflation
3. skin prick test OR
   Allergen specific serum IgE - for allergen triggers

Question 17

PEF vs Spirometry

Question 18

FEV1/FVC ratio

Question 19

Causes of uncontrolled asthma

Answer 19

1. poor inhaler technique
2. poor adherence to medications
3. incorrect diagnosis
4. comorbidities & complicating conditions
5. ongoing exposure to sensitising/irritants home/work

Question 20

correct inhaler technique

Question 21

types of resp failure, which one is asthma’s

Question 22

oxygen delivery devices

Question 23

6 classes of asthma medications

Answer 23

B2 agonist, muscarinic antagonist, UCS, LTRA, methylxanthine, mast cell stabilizer