Asthma

Question 1

Clinical Presentation of Asthma

Answer 1

Wheezing, cough, difficulty exhaling, nighttime symptoms more common.

Question 2

Pathomechanism of Asthma

Answer 2

Caused by reversible smooth muscle contraction in bronchi + hypersecretion
fo mucus.
Usually due to hypersensitive IgE response

Question 3

Classification of Asthma (Traditional)

Answer 3

■ I: Intermittent. Symptoms < 2/week, brief exacerbations FEV1 > 80% of normal.

■ II: Mild Persistent. Symptoms 3-6 times/week, not daily. FEV1 > 80% of normal.

■ III: Moderate Persistent. Symptoms daily. FEV1 btwn 60-80% of normal.

■ IV: Severe Persistent: Continuous symptoms. FEV1 < 60% of normal.

Question 4

Classification of Asthma (GINA)

Answer 4

■ Mild asthma: well-controlled with low-dose ICS

■ Moderate asthma: well-controlled with low-dose ICS + LABA

■ Severe asthma: requires high-dose ICS/LABA to prevent, may still be uncontrolled

Question 5

Diagnosis of Asthma

Answer 5

■ Spirometry: FEV1/FVC <0.8 + improves significantly with salbutamol
■ Methacholine challenge: significantly reduces FEV1

Question 6

Therapy of Asthma

Answer 6

*Stepwise ladder of adding more drugs :
1)Start with and always include SABA (intermittent asthma)
2) If still uncontrolled add inhaled low-dose ICS or cromolyn/leukotriene antagonist (mild persistent)
3) If still uncontrolled begin using low-dose ICS + LABA or medium-dose ICS (moderate persistent),
4) If still uncontrolled begin using high-dose ICS + LABA (severe persistent)
5) If still uncontrolled add oral corticosteroids + consider biologics (Omalizumab)