Asthma

Question 1

How common is asthma?

Answer 1

-1 in 11 children / 1 in 12 adults
-The most common chronic medical condition in children

Question 2

What causes asthma?

Answer 2

-Characterised by PAROXYSMAL and REVERSIBLE OBSTRUCTION of the airways
-Understood as inflammatory combined with bronchial hyper-responsiveness
-Acute asthma has 2 key features:
1. Bronchospasm
2. Excessive secretion production
-Inflammatory cascade occurs on exposure to triggers

Question 3

What risk factors are there for asthma?

Answer 3

-PMH / FH of atopy
-FH of asthma
-Inner city living
-Obesity
-Prematurity and LBW
-Viral infections in early childhood
-Smoking
-Maternal smoking
-Early exposure to broad-spectrum abx

Question 4

How does asthma present?

Answer 4

-Wheeze
-Breathlessness
-Chest tightness
-Cough
-Symptom pattern:
–Worse at night or early in the morning
–Present in response to exercise, allergen exposure or cold air
–Worsen after taking aspirin or beta blockers

Question 5

What signs might an asthma patient have on examination?

Answer 5

-Low FV1 / peak expiratory flow
-May be using accessory muscles / be cyanosed in severe cases
-Peripheral blood eosinophilia
-Increased expiratory phase compared to inspiratory

Question 6

What are the differential diagnoses for asthma?

Answer 6

Children:
-Bronchiolitis
-CF
-Vocal cord dysfunction
-GORD
-Inhalation of a foreign body
-Bronchiectasis
-TB
Adults:
-COPD
-Heart failure
-CHD
-Malignancy
-GORD
-PE
-TB, pulmonary fibrosis

Question 7

How would you investigate a patient with suspected asthma?

Answer 7

-Thorough history including triggers and symptom pattern
-Spirometry (peak flow used in management)

Question 8

What treatment would you consider for a patient with asthma?

Answer 8

4 key principles:
-Symptom control
-Exacerbation prevention
-Achieve best possible lung function
-Minimise side effects
5 step drug treatment:
STEP 1 (mild) - b2-agonist inhaler for PRN use
STEP 2 - regular inhaled steroid eg beclomethasone, for those using b2-agonist frequently etc
STEP 3 - add on a LABA eg salmeterol (increase steroid if no / minimal effect)
STEP 4 - if persistent poor control, increase inhaled steroid up to 2000mcg/day
STEP 5 - add on oral steroids