Asthma

Question 1

What is asthma?

Answer 1

Reversible airway obstruction which responds to bronchodilators such as salbutamol

Question 2

Typical triggers of asthma?

Answer 2

Cold, infection, night time or early morning, exercise, animals, dust and strong emotions

Question 3

Presentation suggesting asthma?

Answer 3

Episodic symptoms, diurnal variability, dry cough with wheeze and sob, history of atopic conditions eczema and hay fever, family history, bilateral widespread polyphonic wheeze

Question 4

What indicates a viral induced condition?

Answer 4

Wheeze related to cough and cold

Question 5

What does unilateral wheeze suggest?

Answer 5

Focal lesion or infection

Question 6

First line investigations for asthma?

Answer 6

Fractional exhaled nitric oxide
Spirometry with bronchodilator reversibility

Question 7

If after first line investigations there is uncertainty then use?

Answer 7

Peak flow variability 2-4 weeks
Direct bronchial challenge test with histamine or methacholine

Question 8

Which are the reliever or rescue medication?

Answer 8

SABA- Adrenalin acts on smooth muscle causing dilation

Question 9

Which are the maintenance or preventer medications?

Answer 9

ICS beclometasone

Question 10

How do LAMA work?

Answer 10

Block acetylcholine receptors, which are stimulated by parasympathetic nervous system causing contraction

Question 11

What do leukotrienes cause?

Answer 11

Inflammation, bronchoconstriction and mucus secretion

Question 12

Theophylline mechanism and important point?

Answer 12

Relaxes bronchial smooth muscle and reduces inflammation.
Narrow therapeutic index toxic in excess, monitor 5 days after starting and 3 days after dose change

Question 13

What is MART?

Answer 13

ICS and fast acting LABA

Question 14

Order of drugs?

Answer 14

1. SABA
2. ICS
3. LTRA
   4.LABA
4. MART
5. ICS to moderate dose
6. ICS to high dose or LAMA or oral theophylline
7. Specialist

Question 15

How many people die with asthma every year in UK?

Answer 15

1000

Question 16

What type of hypersensitivity is asthma?

Answer 16

1

Question 17

What is the predominant response?

Answer 17

Th2

Question 18

How is occupational asthma diagnosed?

Answer 18

Reduced peak flows during week and weekend

Question 19

Occupational allergens include?

Answer 19

Flour and isocyanates (spray painting and foam moulding), platinum salts, resin, gluteraldehyde, proteolytic enzymes

Question 20

Symptoms of asthma?

Answer 20

Cough, sob and wheeze/ chest tightness

Question 21

Signs of asthma?

Answer 21

Expiratory wheeze on auscultation
Reduced PEFR

Question 22

Spirometry results in asthma?

Answer 22

FEV1 Reduced, FVC normal and FEV1% less than 70

Question 23

Why do FENO test?

Answer 23

Nitric oxide produced by 3 synthase, one which is inducible and levels tend to rise inflammatory cells (eosinophils)

Question 24

Side effect of salbutamol?

Answer 24

Tremor

Question 25

Side effects of ICS?

Answer 25

Stunted growth in children Oral candidiasis

Question 26

Examples of ICS?

Answer 26

Beclometasone dipropionate fluticasone and propionate

Question 27

Children under 17 should have which tests?

Answer 27

Spirometry with bronchodilator reversibility. If negative then FeNO

Question 28

When is FeNO positive?

Answer 28

Adults>=40 parts per billion and in children 35 parts per billion

Question 29

Reversibility testing?

Answer 29

Improvement in FEV1 of 12% or more and increase in volume of 200ml in adults In children, improvement in FEV1 of more than 12%

Question 30

What is difference in low dose, moderate and high ICS?

Answer 30

Less than 400 micrograms, 400-800, more than 800

Question 31

How to reduce dose of inhaled steroids?

Answer 31

25-50% at a time

Question 32

How often should you consider stepping down?

Answer 32

3 months

Question 33

Presentation of acute asthma

Answer 33

Progressively worsening sob Accessory muscles Tachypnoea Symmetrical expiratory wheeze Tight chest with reduced air entry

Question 34

Moderate grading of acute asthma?

Answer 34

PEFR 50-75

Question 35

Severe grading of Acute asthma?

Answer 35

PEFR 33-50 Resp rate>25 Heart rate>110 Unable to complete full sentences

Question 36

Life threatening acute asthma?

Answer 36

PEFR less than 33 Sats less than 92 Becoming tired No wheeze- silent chest Haemodynamically unstable- shock Bradycardia dysrhythmia or hypotension Exhaustion, confusion or coma

Question 37

How to treat moderate acute asthma?

Answer 37

Nebuliser beta 2 agonist- salbutamol 5mg Nebuliser ipratoprium bromide Steroids- oral prednisolone and IV hydrocortisone- 5days Antibiotic if infection

Question 38

Treatment for severe acute asthma?

Answer 38

Oxygen to maintain sats Aminophylline infusion IV salbutamol

Question 39

Life threatening acute asthma treatment?

Answer 39

IV magnesium sulphate infusion HDU/ICU Intubation

Question 40

ABGs in asthma?

Answer 40

Respiratory alkalosis blowing CO2 off, if tiring hypoxia and normal CO2- life threatening asthma. Respiratory acidosis- high CO2 very bad sign

Question 41

What should you monitor when giving salbutamol?

Answer 41

Serum potassium- absorbed into cells. Can cause tachycardia.

Question 42

When do you refer to specialist?

Answer 42

If more than 2 attacks in 12 months

Question 43

What is near fatal asthma?

Answer 43

Raised CO2 or requiring mechanical ventilation with raised inflation pressures

Question 44

When to do ABG?

Answer 44

Sats less than 92

Question 45

When to do CXR?

Answer 45

Life threatening asthma, suspected pneumothorax, failure to respond to treatment

Question 46

Criteria for discharge?

Answer 46

No oxygen or nebulisers for 12-24 hours PEF more than 75 Inhaler technique checked

Question 47

ITU/HDU treatment options?

Answer 47

Intubation and ventilate ECMO- blood pumped outside body to machine which removes CO2 and puts oxygen into blood