Asthma

Question 1

What are symptoms of asthma?

Answer 1

Wheeze, Dyspnoea, Nocturnal cough, Chest tightness, Diurnal variation (cortisol is immunosuppressive so less cortisol at night = less immunosuppression = more symptoms)

FHx of allergy/atopy may be present. Symptoms may worsen following exercise/NSAIDs/beta blockers.

Question 2

What are signs of asthma?

Answer 2

Tachypnoea, hyperinflated chest, hyper-resonance, decreased air entry, wheeze on auscultation

Question 3

What are signs of a severe asthma attack?

Answer 3

Inability to speak complete sentences, resp rate >25, peak flow 33-50% of predicted

Question 4

What are signs of a life-threatening asthma attack?

Answer 4

Silent chest, confusion, bradycardia, cyanosis, exhaustion

Question 5

What is complete control of asthma?

Answer 5

No daytime symptoms
No nightime awakening
No asthma attacks
No limitations on activity
Normal lung function (FEV1/FVC = 80%)
Minimal side effects from medications

Question 6

How does spirometry differ between obstructive/restrictive conditions?

Answer 6

Obstructive: Ratio of less than 0.7
Restrictive: Ratio above that but volumes less than we’d expect to see

Question 7

How is chronic asthma diagnosed?

Answer 7

1. Clinical symptoms + spirometry show obstructive picture
2. Reversible airway obstruction is definitive diagnosis - 12% increase in ratio post bronchodilator use
3. PEFR shows diurnal variation - daily diurnal variability of >10% for 2 weeks.
4. FeNO >40ppb as inflammatory cells produce this

Question 8

What tests are done after a formal diagnosis of asthma is made?

Answer 8

1. Airway hyperreactivity testing: Histamine/Methacholine direct bronchial challenge
2. Allergy testing (skin prick/radioallergosorbent testing)
3. Bloods - eosinophilia, IgE, aspergillus antibody titres

Question 9

What is the treatment algorithm for asthma?

Answer 9

1. SABA
2. SABA + low dose ICS
3. SABA + low dose ICS + LRTA
4. SABA + low dose ICS + LABA (consider stopping LRTA)
5. SABA +/- LRTA (switch ICS/LABA to MART) - MART is combined LABA and low-dose ICS)
6. Same as previous but higher dose ICS

Question 10

What are side effects of common drugs used to treat asthma?

Answer 10

SABA - tremors
ICS - candida/oral thrush

Question 11

How can a patient with acute asthma present?

Answer 11

Severe breathlessness, wheeze, possible chest tightness

Question 12

What investigations are carried out for an acute asthma attack?

Answer 12

1. ABCDE
2. Basic obs
3. ABG - Sp02, low CO2 due to hyperventilation (resp failure, acidosis)
4. PEFR + bedside spirometry - moderate (50-75%), severe (33-50%), life threatening (<33%)

Question 13

Why is PEF important in asthma?

Answer 13

1. Correlates with FEV1 estimating airway calibre
2. Higher FEV1 desired and this depends on age/gender

How to use:
1. Stand/sit-up + hold device straight
2. Take maximal inhalation
3. Blow into tube making sure slider is at start point
Do 3 times with highest result recorded - used in acute situations to determine severity of attack

Question 14

What does the ABCDE approach include?

Answer 14

Airways: head tilt/lift chin –> NP/Guedel/Igel
Breathing: O2, sats, RR, listen to chest, ABG, potential CXR, NRB mask, BVM
Circulation: HR, BP, capillary refill, ECG, 2wb cannulae, bloods, IV fluids, catheter
Disability: DEFG (

Question 15

How is an acute asthma attack treated?

Answer 15

OSHITME
O: Oxygen to maintain sats of 94-98%
S: Salbutamol 5mg nebs/terbutaline 10mg
H: Hydrocortisone 100mg IV/pred 40mg PO
I: Ipratropium (immediate if severe, in 15 mins if mod patient doesnt improve)
T: Theophylline
M: Magnesium sulfate 1.2-2.0g over 20 mins IV
E: Escalate to ICU

Question 16

What are complications of asthma?

Answer 16

Recurrent infections
Pneumothorax
Respiratory failure
Death

Question 17

What is the prognosis of asthma?

Answer 17

Children improve as they grow older
Adult onset asthma usually chronic