Asthma

Question 1

What is the definition of asthma?

Answer 1

Question 2

What is the prevalence of asthma in irish population?

Answer 2

Question 3

What are the RFs for developing asthma?

Answer 3

Question 4

What is the pathogenesis of asthma?

Answer 4

Question 5

What are the the types of asthma?

Answer 5

Question 6

What type of asthma is associated with steroid responsiveness?

Answer 6

Eosinophilic (It is also the one with basement membrane thickening)

Question 7

What type of asthma is the classical type of asthma

Answer 7

Eosinophilic as it is the one with basement membrane thickening

Question 8

What cells are typically involved in the pathogenesis of eosinophilic asthma?

Answer 8

IgE => Mast cells, eosinophils, and TH2 lymphocytes

Question 9

What cells are involved in mucous secretion in the airways?

Answer 9

Goblet cells. Hypertrophied in asthma

Question 10

Explain the pathogenesis of an asthma exacerbation

Answer 10

Question 11

What are atopic features. Give 4

Answer 11

Eczema, rhinitis, Eosinophilic oesophagitis

Question 12

What are the main symptoms of asthma?

Answer 12

Wheeze + chest tightness
Cough +/- sputum
Dyspnoea
Atopic Features: Eczema, rhinitis, Eosinophilic oesophagitis

Question 13

What are the common triggers for asthma exacerbation?

Answer 13

Question 14

What questions would you ask a patient in an asthma history?

Answer 14

Question 15

How would you determine the severity of an asthma based on peak flow?

Answer 15

Question 16

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?

Answer 16

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

Question 17

What findings would be consistent with asthma medications?

Answer 17

Tremor
oral Candidiasis

Question 18

What examination findings would you expect in a patient with an asthma exacerbation?

Answer 18

Question 19

Differentiate between a Severe vs life threatening asthma attack.

Answer 19

Question 20

List some ddx for Asthma.

Answer 20

Question 21

What is the definition of obstructive airway disease?

Answer 21

FEV1/FVC <0.7

Question 22

What findings on spirometry would be diagnostic of asthma?

Answer 22

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

Question 23

What will the Peak flow diary in asthma show?

Answer 23

Diurnal variation >20%
+ Triggers, exacerbations…

Question 24

What diagnostic investigation for asthma is primarily used to outrule it rather than confirm?

How is it performed?

Answer 24

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

Question 25

What do you expect to see on an FBC of an asthma patient?

Answer 25

Raised eosinophils Note: Must order FBC with differentials

Question 26

What is the role of IgE/RAST panel in asthma?

Answer 26

Screens for triggers of asthma

Question 27

What are the diagnostic investigations for asthma with expected findings?

Answer 27

Question 28

How would you investigate a patient with asthma? Justify each.

Answer 28

Question 29

Give the full management of an acute asthma exacerbation.

Answer 29

Question 30

What is the prevention strategy/non-pharmacological for asthma

Answer 30

Question 31

What is Symbicort?

Answer 31

ICS/LABA combination inhaler Budenoside/Fomoterol

Question 32

LTRAs are recommended mostly for those with allergic rhinitis. What is an LTRA? Give an example.

Answer 32

Leukotriene receptor antagonist Montelukast

Question 33

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?

Answer 33

Tiotropium (LAMA) Biologics Oral corticosteroids (Pred)

Question 34

Give 2 examples of Biologics used in the management of asthma How would you decide which to use?

Answer 34

Omalizumab for high IgE Mepolizumab for high eosinophils Reblizumab

Question 35

What type of medication is Omalizumab? How often is it administered? What is the indication to use this medication over the other biologics?

Answer 35

Anti-IgE monoclonal antibody Given every 4 weeks Indicated in a patient with uncontrolled asthma despite exhaustion of GINA and high IgE

Question 36

What type of medication is Mepolizumab? How often is it administered? What is the indication to use this medication over the other biologics?

Answer 36

Anti ILS monoclonal antibody Also administered every 4 weeks Indicated in a patient with uncontrolled asthma despite exhaustion of GINA and high eosinophils

Question 37

What is the pharmacological management of asthma (including escalations)

Answer 37

Question 38

How would you manage a patient with asthma?

Answer 38

Question 39

What are 4 complications of asthma?

Answer 39

Question 40

Compare the prognosis of asthma acquired in childhood vs in adulthood.

Answer 40

Question 41

What is this?

Answer 41

Peak flow meter

Question 42

What is this?

Answer 42

Spirometry (PFTs)