Asthma

Question 1

What is asthma

Answer 1

Chronic inflammation of the airways, hyper responsive airways

Question 2

What are the symptoms of asthma

Answer 2

Dyspnoea, cough, wheeze

Question 3

What happens to smooth muscle and airway membranes in asthma?

Answer 3

Smooth muscle hypertrophy

Thickening and disruption of airway membrane

Question 4

Risk factors for asthma

Answer 4

Family history of atopy (maternal atopy most influential), male sex (asthma development), female sex (asthma persistence into adulthood), premature/low birth weight, smoking, obesity, occupational dusts

Question 5

What triggers childhood asthma

Answer 5

Usually a URTI

Question 6

What is genetic involvement in asthma

Answer 6

30-80%

Question 7

What signs/symptoms in history indicate asthma

Answer 7

Wheeze, cough, dyspnoea, episodic diurnal symptoms

Common triggers, occupation, family history, smoking history

Question 8

On examination what may you find

Answer 8

May be normal between exacerbations

Increased work of breathing, cyanosis, cough

Question 9

What are side effects of salbutamol use

Answer 9

Fine tremor

Question 10

Side effect of inhaled corticosteroids inhaler

Answer 10

Oral candidiasis

Reduced height if given to children

Question 11

What WOULDN’T you find in asthma

Answer 11

Nail clubbing, stridor, asymmetrical chest expansions, creps

Question 12

What variability in twice daily PEFR suggests asthma (over 2wks)

Answer 12

20%

Question 13

What are you looking for in blood tests for asthma

Answer 13

CRP and white blood cell count to rule out infection

High eosinophil found and total IgE suggestive for asthma

Question 14

What would you expect to see on CXR of asthma

Answer 14

Typically Normal - may show Hyperinflation

Important for ruling out differential diagnosis

Question 15

What would you expect to see in spirometry of asthma

Answer 15

FEV1/FVC <70% (obstructive pattern)

Reversibility testing with bronchodilator

Question 16

What exhaled nitric oxide would you expect to see in asthma

Answer 16

High FeNO

Question 17

How to decipher between COPD and asthma

Answer 17

pulmonary function test (DLCO)

Lungs ability to diffuse carbon monoxide

• decreased in COPD
• normal or increased in asthma

Question 18

What is the stepped approach in asthma

Answer 18

Low dose ICS (brown inhaler) +/- SABA when necessary (blue inhaler) —> add LABA (green inhaler) —> increase ICS or add oral LTRA

Question 19

What is first line of treatment for asthma in <5y.o.

Answer 19

LTRA

Question 20

Criteria for moderate asthma attack and treatment

Answer 20

able to speak
HR below 110
respiratory rate below 25
PEFR 50-75%
PO2 and sats OK
reduced PCO2

Treatment = treat trigger and administer inhaler/oral steroid

Question 21

Criteria and treatment for severe asthma attack

Answer 21

any one of:

• inability to complete sentences in one breath
• HR above110
• respiratory rate above 25
• PEFR 33-50%
• PO2 and sats OK
• reduced PCO2

admit, nebulise, IV hydrocortisone three times a day, oral prednisolone once a day

Question 22

Criteria of life threatening asthma

Answer 22

any one of:
- arrhythmia, grunting, impaired consciousness,
confusion, exhaustion, bradycardia, hypotension, cyanosis, silent chest, poor respiratory effect,
- PEFR below 33%
- sats below 92%
- PO2 below 8kPA
- normal PCO2 (4.6-6.0kPa)

Question 23

Criteria and treatment of near fatal asthma

Answer 23

Near fatal asthma attack > raised PCO2

mechanical ventilation necessary

Question 24

Treatment of asthma attacks

Answer 24

oxygen if sats below 94% —> nebulised salbutamol —> hydrocortisone/oral prednisolone —> nebulised ipratropium bromide (muscarinic antagonist) —> one dose magnesium sulphate

Question 25

How to treat >5s with suspected asthma

Answer 25

2 month ICS followed by inhaler holiday around Easter time to rule out false positives

this trial may reduce final adult height by 0.5-1cm

Question 26

How to assess paediatric asthma control

Answer 26

S = SABA/per week, more than twice indicates
poor control
A = absence from school/nursery
N = nocturnal symptoms
E = exacerbation symptoms

Question 27

Benefits of spacers

Answer 27

Increase delivery 4 fold

Question 28

When should dry powder not be used

Answer 28

<8y.o or low dexterity