Asthma

Question 1

Definition of asthma.

Answer 1

A chronic inflammatory disorder of the airways.
In susceptible individuals, inflammatory symptoms are usually associated with widespread but variable airflow obstruction and an increase in airway response to a variety of stimuli. Obstruction is often reversible, either spontaneously or with treatment.”
- British Thoracic Soc.

Question 2

Why are stimuli known as triggers for asthma?

Answer 2

The stimuli are known as triggers because they trigger the asthma attack or trigger bronchoconstriction.

Question 3

What is the underlying pathology of asthma?

Answer 3

Inflammation of the bronchial tree with hyper-reactivity of the lungs to stimuli.

Question 4

Long term changes can occur in those having chronic asthma, causing structural changes to the actual airways themselves aka airway remodeling.
List some structural changes which can occur.

Answer 4

Sub-epithelial fibrosis
Increased smooth muscle mass
Enlargement of submucosal glands
Neovascularisation
Epithelial alterations

Question 5

List some stimuli which can trigger asthma.

Answer 5

Allergens
Infections - URT infection
Pollutants - cigarette smoke, sulpher dioxide, nitrous oxides
Weather - cold air/pollen
Occupational - working with chemicals/ particles
Drugs - NSAIDs
Exercise - due to loss of heat and moisture
Stress

Question 6

What is episodic/seasonal asthma?

Answer 6

Occurs at intervals throughout year e.g. pollen season.

Question 7

What is chronic asthma?

Answer 7

Persistent disease state with acute exacerbations periodically.

Question 8

What is exercise induced asthma?

Answer 8

Airways sensitive to colder, drier air. Also occurs due to loss of moisture and heat.

Question 9

What is childhood asthma?

Answer 9

Asthma due to allergic reactions during childhood. Resolves as child ages.

Question 10

What is late-onset asthma?

Answer 10

Asthma presenting for first time in adults.

- common in female patients - need higher doses of ICS to control.

Question 11

What is Status asthmaticus (severe acute asthma)?

Answer 11

A long-lasting severe acute attack. Aggressive early treatment needed.

Question 12

What is extrinsic asthma?

Answer 12

Allergy or IgE related asthma.

Question 13

What is intrinsic asthma?

Answer 13

Non-IgE related asthma.

Question 14

What is the effect on parasympathetic and sympathetic stimulation on wairways?

Answer 14

Parasympathetic stimulation causes bronchoconstriction.

Sympathetic stimulation causes bronchodilation.

Question 15

What are some symptoms of asthma for diagnosis (can be misdiagnosed due to many respiratory conditions having same symptoms)?

Answer 15

Wheezing, shortness of breath, chest tightness, cough

Question 16

Name some objective tests which can be used to diagnose and monitor progress of asthma.

Answer 16

Peak expiratory flow test
Reversibility tests 
FeNO test 
Skin tests
Chest radiographs

Question 17

How do you measure PEF and what does it tell you?

Answer 17

Use Peak Flow Meter.

Device tells you the maximum rate at which you can expel air from lungs.

Question 18

What are some non-pharmacological treatments for asthma?

Answer 18

Avoidance of triggers, desensitisation to specific allergen (immunotherapy), house dust mite control, smoking cessation, weight reduction.

Question 19

Stimulation of B2 receptors increases cAMP. What is the effect of this?

Answer 19

Leads to airway relaxation.

Question 20

What is a major advantage of using combination inhalers?

Answer 20

They aid adherence and ensure that ICS is not taking without a LABA.

Question 21

Which LABA has a similar onset of action to salbutamol?

Answer 21

Formoterol.

Rapid onset like salbutamol.

Question 22

What are some adverse effects of B2 adrenoceptor agonists?

Answer 22

Tachycardia, tremor, cramps, hypokalaemia.

Question 23

Give advantages of using spacer devices.

Answer 23

Creates space between inhaler and oropharynx - gives patient more time to inhale.
Removes need for synchronisation.
Are product specific.

Question 24

Give the disadvantages of using spacer devices.

Answer 24

Very bulky to carry (but bigger the better).
Distance between spacer and oropharynx - drug is deposited in spacer - doesn’t reach intended site.
Care must be taken while washing device.

Question 25

When is a spacer device needed?

Answer 25

For children under 5 with any MDI.

Child under 16 with a steroid MDI.

Question 26

Describe the cleaning process of spacer device.

Answer 26

Wash monthly only, in detergent and let it air dry.
Wiping interior - electrons will be removed from spacer - will become statically charged so drug particles will be stuck to device - will not enter airways.

Question 27

If DPI and MDI are used correctly, how much should end up in the oropharynx?

Answer 27

80%.

Question 28

What can corticosteroid deposition cause? How can patient avoid this?

Answer 28

Cause candidiasis (oral thrush), hoarseness, dysphonia, throat irritation.
Reduced by washing mouth after ICS use.

Question 29

What does the high use of short -acting B2 agonists indicate?

Answer 29

Poor control of asthma - must be checked out.