Asthma Flashcards
What is the definition of asthma?
What is the prevalence of asthma in irish population?
What are the RFs for developing asthma?
What is the pathogenesis of asthma?
What are the the types of asthma?
What type of asthma is associated with steroid responsiveness?
Eosinophilic (It is also the one with basement membrane thickening)
What type of asthma is the classical type of asthma
Eosinophilic as it is the one with basement membrane thickening
What cells are typically involved in the pathogenesis of eosinophilic asthma?
IgE => Mast cells, eosinophils, and TH2 lymphocytes
What cells are involved in mucous secretion in the airways?
Goblet cells. Hypertrophied in asthma
Explain the pathogenesis of an asthma exacerbation
What are atopic features. Give 4
Eczema, rhinitis, Eosinophilic oesophagitis
What are the main symptoms of asthma?
Wheeze + chest tightness
Cough +/- sputum
Dyspnoea
Atopic Features: Eczema, rhinitis, Eosinophilic oesophagitis
What are the common triggers for asthma exacerbation?
What questions would you ask a patient in an asthma history?
How would you determine the severity of an asthma based on peak flow?
What is the typical auscultation of most patients with asthma?
What is the typical auscultation of a patient with asthma of mild/moderate exacerbation?
What if it severe?
What if it was life-threatening?
Normal: asymptomatic => normal breath sounds (vesicular)
Mild exacerbation: Reduced breath sounds, vesicular breathing, Expiratory wheeze with prolonged expiratory phase
Severe: biphasic wheeze
Silent chest => Absent breath sounds
What findings would be consistent with asthma medications?
Tremor
oral Candidiasis
What examination findings would you expect in a patient with an asthma exacerbation?
Differentiate between a Severe vs life threatening asthma attack.
List some ddx for Asthma.
What is the definition of obstructive airway disease?
FEV1/FVC <0.7
What findings on spirometry would be diagnostic of asthma?
Spirometry + Reversibility testing displaying
1) obstructive airway disease (FEV1/FVC <0.7)
2) Salbutamol reversibility with 12% increase in FEV 1 and 200ml increase in volume
What will the Peak flow diary in asthma show?
Diurnal variation >20%
+ Triggers, exacerbations…
What diagnostic investigation for asthma is primarily used to outrule it rather than confirm?
How is it performed?
Histamine or Methacholine Bronchoprovocation challenge
1) Baseline spirometry is performed
2) Control solution (which does not cause bronchoconstriction is trialled)
3) Then Histamine or methacholine is administered (inhalation) and spirometry is performed again assessing for hyperresponsiveness (FEV1)
But remember its only rly used to outrule asthma
What do you expect to see on an FBC of an asthma patient?
Raised eosinophils
Note: Must order FBC with differentials
What is the role of IgE/RAST panel in asthma?
Screens for triggers of asthma
What are the diagnostic investigations for asthma with expected findings?
How would you investigate a patient with asthma? Justify each.
Give the full management of an acute asthma exacerbation.
What is the prevention strategy/non-pharmacological for asthma
What is Symbicort?
ICS/LABA combination inhaler
Budenoside/Fomoterol
LTRAs are recommended mostly for those with allergic rhinitis.
What is an LTRA?
Give an example.
Leukotriene receptor antagonist
Montelukast
You’ve gone through the GINA guidelines escalating the patient appropriately but the patient still doesnt have their asthma controlled. Youve also ensured that their technique was right and kept up with asthma diary.
What are the escalations after that?
Tiotropium (LAMA)
Biologics
Oral corticosteroids (Pred)
Give 2 examples of Biologics used in the management of asthma
How would you decide which to use?
Omalizumab for high IgE
Mepolizumab for high eosinophils
Reblizumab
What type of medication is Omalizumab?
How often is it administered?
What is the indication to use this medication over the other biologics?
Anti-IgE monoclonal antibody
Given every 4 weeks
Indicated in a patient with uncontrolled asthma despite exhaustion of GINA and high IgE
What type of medication is Mepolizumab?
How often is it administered?
What is the indication to use this medication over the other biologics?
Anti ILS monoclonal antibody
Also administered every 4 weeks
Indicated in a patient with uncontrolled asthma despite exhaustion of GINA and high eosinophils
What is the pharmacological management of asthma (including escalations)
How would you manage a patient with asthma?
What are 4 complications of asthma?
Compare the prognosis of asthma acquired in childhood vs in adulthood.
What is this?
Peak flow meter
What is this?
Spirometry (PFTs)
