Asthma

Question 1

is asthma an acute or chronic inflammatory condition of the airways

Answer 1

chronic

Question 2

asthma is associated with the hyper responsiveness of the airways and variable flow obstruction, bronchial hyperreactvity is a key feature and results in what?

Answer 2

asthmatic response based on particular triggers

Question 3

exposure to triggers causes constriction of airway smooth muscle which results in

Answer 3

bronchoconstriction

Question 4

bronchoconstriction is a result of the activation of x nervous system

Answer 4

parasympathetic

Question 5

bronchoconstriction causes the release of ach which activates the x receptors in airway smooth muscle

Answer 5

m3 muscarinic

Question 6

what is consequence of activation of m3 muscarinic receptors

Answer 6

contraction of smooth muscles and constriction of diameter airway

Question 7

inflammation results in the production of x and y in the airway

Answer 7

excess mucus and oedema

Question 8

the combination of bronchoconstriction and inflammation results in the classic symptoms of asthma which are

Answer 8

breathlessness
cough
wheeze

Question 9

frequency and severity of asthma symptoms can vary between the same person and among different people but often has diurnal variation, what is meant by this

Answer 9

increased symptoms at night and first thing in morning

Question 10

asthma is diagnosed from an accurate clinical history which is used in conjunction with

Answer 10

objective diagnostic test

Question 11

what is the purpose/ benefit of doing an objective diagnostic test for asthma diagnosis

Answer 11

provide evidence and allow for monitoring of progress and response to treatment

Question 12

what different things should a clinical history check for

Answer 12

wheeze
cough breathlessness
variation in symptoms
triggers
personal or family history of atopic disorders

Question 13

what procedure to listen for wheeze is an important part of the physical examination done alongside clinical history

Answer 13

chest auscultation

Question 14

name some other objective tests that are used to investigate asthma

Answer 14

feno
spirometry
peak flow

Question 15

FeNO (fractional exhaled nitric oxide) is a relatively new test, what does it measure and provide an indication of

Answer 15

measures level of no in exhaled breath and provides indication of eosinophilic inflammation in the lungs

Question 16

name a test that can be used to facilitate an asthma diagnosis so that patients do not have to be referred to secondary care for additional testing such as spirometry

Answer 16

FeNO

Question 17

a feno level above x ppb is considered to be a positive test and therefore supports a diagnosis of asthma

Answer 17

40

Question 18

name a test that can be used to look for eosinophilic inflammation in the lungs

Answer 18

feno

Question 19

what rr would you expect to see in acute severe asthma

Answer 19

equal or more than 25 breaths/min

Question 20

what pulse rate would you expect to see in acute severe asthma

Answer 20

equal or more than 110 beats/min

Question 21

list some life threatening features of acute severe asthma

Answer 21

ox below 92
silent chest
cyanosis
poor resp effort
arrythmia
hypotension
exhaustion

Question 22

step 1 is regular preventor: low dose ICS, whats next?

Answer 22

add on
inhaled LABA

Question 23

step 2 additional controller therapies - consider what?

Answer 23

increasing ICS to med dose
or
add LTRA

… if no response to LABA, stop

Question 24

CHECK INHALER TECHNIQUE

ICS
combination
SABA
LAMA

Question 25

when asthma control is poor patients should be stepped up but what should be checked before this

Answer 25

adherence
inhaler technique
potential triggers

Question 26

name some identified triggers for asthma

Answer 26

allergens: moulds, pollen
infectious agents: influenza
drugs: nsaids, bb, prostaglandins
occupational: latex
hair colourants
other: cold air
stress

Question 27

A patient is complaining of shortness of breath, what should you ask about in the clinical history to see if asthma is a possible differential diagnosis?

Answer 27

Clinical history should check for:

wheeze, cough or breathlessness and any daily or seasonal variation in these symptoms
any triggers that make symptoms worse
a personal or family history of atopic disorders

Question 28

When (and why) is magnesium used in the management of asthma?

Answer 28

in severe cases as adjunct to standard therapy as it has been shown to cause bronchial smooth muscle relaxation

Question 29

what route is magnesium given in asthma? severe

Answer 29

10-20min IV infusion

Question 30

why might magnesium be beneficial in acute asthma compared to a drug like theophylline

Answer 30

safe and inexpensive