Asthma

Question 1

Asthma

Answer 1

Chronic inflammatory condition of the airways

Causes episodic exacerbations of bronchoconstriction

Question 2

Typical triggers

Answer 2

Infection

Night time or early morning

Exercise

Animals

Cold/damp

Dust

Strong emotions

Question 3

Presentation

Answer 3

Episodic symptoms

Diurnal variability (typically worse at night)

Dry cough with wheeze and SOB

History of atopy

Family history

Bilateral widespread ‘polyphonic’ wheeze

Question 4

BTS guidelines on diagnosis

Answer 4

High probability clinically: try treatment

Intermediate probability: spirometry with reversibility testing

Low probability: referral and investigate for other causes

Question 5

NICE guidelines on diagnosis

Answer 5

First line
- fractional exhaled nitric oxide
- spirometry with bronchodilator reversibility

Further testing
- peak flow variability
- direct bronchial challenge with histamine or methacoline

Question 6

Spirometry findings

Answer 6

FEV1 significantly reduced

FVC normal

FEV1/FVC <70%

Question 7

Step 1 management

Answer 7

Newly-diagnosed asthma

Short-acting beta agonist

Question 8

Step 2 management

Answer 8

Not controlled on previous step or newly-diagnosed asthma with symptoms >3x week or night time waking

SABA + low dose inhaled corticosteroid

Question 9

Step 3

Answer 9

SABA + low dose ICS + leukotriene receptor antagonist

Question 10

Step 4

Answer 10

SABA + low dose ICS + long acting beta agonist

Continue LTRA depending in patient’s response

Question 11

Step 5

Answer 11

SABA +/- LTRA

Switch ICS/LABA for maintenance and reliever therapy (MART) that includes low-dose ICS

Question 12

Step 6

Answer 12

SABA +/- LTRA + medium-dose ICS MART

Question 13

Additional management

Answer 13

Individual asthma self-management programme

Yearly flu jab

Yearly asthma review

Advise exercise and avoid smoking