asthma

Question 1

what is asthma?

Answer 1

airway hyperreactivity to non-specific stimuli, leading to airway obstruction.

The airway obstruction is due to inflammatory cell infiltration, mucus hypersecretion and smooth muscle contraction.

Question 2

what is the cause of asthma?

Answer 2

genetic and environmental factors.

the hygiene hypothesis suggests that early life exposure to microorganisms and endotoxins switch off the allergic response leading to reduced allergen sensitivity in later life.

Question 3

what are 4 clinical features?

ask about eczema and allergies

Answer 3

cough

dyspnoea

chest tightness

wheeze

Question 4

what investigations are used to diagnose asthma?

Answer 4

peak flow recording and bronchodilator reversibility testing

• FBC for eosinophilia
• CXR if atypical symptoms

Question 5

what are 4 differential diagnoses of asthma?

Answer 5

-Upper airway obstruction
-Foreign body aspiration
-Tumour
-Congestive cardiac failure

Question 6

what is the management of acute asthma?

SHIT ME

Answer 6

O2 (High flow) – to reverse hypoxia and acidosis

Salbutamol (Nebulised) – This may cause hypokalaemia/tachycardia

Hydrocortisone (IV/Oral)

Ipratropium Bromide

Theophylline (IV)

Magnesium Sulphate (IV)

Escalate care? ITU

Question 7

what is the management of chronic asthma?

5 steps

Answer 7

Step 1 – Short-acting β2 agonist, ≥10 puffs per day is a marker of poorly controlled disease

Step 2 – Regular preventer steroids eg. beclomethasone, fluticasone. Titrate to the lowest possible dose

Step 3 – Add on therapy eg. long-acting beta agonist.

Step 4 – Add on therapy eg. leukotriene receptor antagonist, theophylline

Step 5 – Continuous/frequent oral steroids Other management steps:
-Smoking cessation
-Allergen avoidance
-Weight reduction