Asthma

Question 1

What is asthma?

Answer 1

Chronic inflammatory condition of the airways causing episodic exacerbations of bronchoconstriction

Question 2

Typical triggers in asthma

Answer 2

Infection

Night time or early morning

Exercise

Animals

Cold/damp

Dust

Strong emotions

Question 3

Presentation suggesting a diagnosis of asthma

Answer 3

Episodic symptoms

Diurnal variability (typically worse at night)

Dry cough with wheeze and shortness of breath

History of other atopic conditions e.g. eczema, hayfever and food allergies

Family history

Bilateral widespread “polyphonic” wheeze

Question 4

Presentation suggesting a diagnosis other than asthma

Answer 4

Wheeze related to coughs and colds more suggestive of viral induced wheeze

Isolated or productive cough

Normal investigations

No response to treatment

Unilateral wheeze

Question 5

What is a unilateral wheeze suggestive of?

Answer 5

Focal lesion/infection

Question 6

First line investigations for asthma diagnosis

Answer 6

Fractional exhaled nitric oxide

Spirometry with bronchodilator reversibility

Question 7

Further testing for asthma diagnosis

Answer 7

If still diagnostic uncertainty after first line investigations

Peak flow variability measured by keeping a diary of peak flow measurements several times per day for 2 to 4 weeks

Direct bronchial challenge test with histamine or methacholine

Question 8

Long term management of asthma

Answer 8

SABA e.g. salbutamol (reliever/rescue)

Inhaled. corticosteroids e.g. beclometasone (maintenance/preventer)

LABA e.g. salmeterol

LAMA e.g. tiotropium (bronchodilation)

Leukotriene receptor antagonists e.g. montelukast

Theophylline - relaxation of. bronchial smooth muscle, anti-inflammatory

Question 9

Additional management in asthma

Answer 9

Individual asthma self-management programme

Yearly flu jab

Yearly asthma review

Advise exercise and avoid smoking