asthma

Question 1

features of acute asthma,

Answer 1

worsening dyspnoea, cough not responding to salbutamol

Question 2

management of acute asthma

Answer 2

abg if O2< 92%
* admit if life threatening, previous near-fatal, pregnant or attack occurring despite corticosteroid
* oxygen if hypoxaemic
- 15l titrated down until SpO 94-98%
* SABA - standard inhaler (pMDI) or nebulised
corticosteroid - 40-50mg prednisolone PO for 5 days
ipratropium bromide - short acting muscarinic antagonist, given if not responding to saba and corticosteroid or life threatening
IV mg sulfate - severe/life threatening

Question 3

moderate severe and life threatening classification

Answer 3

Moderate
PEFR 50-75% best or predicted
Speech normal
RR < 25 / min
Pulse < 110 bpm
Severe
PEFR 33 - 50% best or predicted
Can’t complete sentences
RR > 25/min
Pulse > 110 bpm
Life-threatening
PEFR < 33% best or predicted
Oxygen sats < 92%
Silent chest, cyanosis or feeble respiratory effort
Bradycardia, dysrhythmia or hypotension
Exhaustion, confusion or coma

Question 4

discharge criteria following acute asthma attack

Answer 4

been stable on their discharge medication (i.e. no nebulisers or oxygen) for 12-24 hours
inhaler technique checked and recorded
PEF >75% of best or predicted

Question 5

asthma risk factors

Answer 5

personal or family history of atopy
antenatal factors: maternal smoking, viral infection during pregnancy (especially RSV)
low birth weight
not being breastfed
maternal smoking around child
exposure to high concentrations of allergens (e.g. house dust mite)
air pollution
‘hygiene hypothesis’: studies show an increased risk of asthma and other allergic conditions in developed countries. Reduced exposure to infectious agents in childhood prevents normal development of the immune system resulting in a Th2 predominant response

Question 6

atopy

Answer 6

genetic tendency to develop IgE-mediated allergic diseases such as allergic rhinitis, asthma and atopic dermatitis (eczema)

Question 7

occupational asthma

Answer 7

10-15% of adult asthma cases
reduced peak flow during working week and normal when not at work
occupational allergens include isocyanates and flour, epoxy resin

Question 8

asthma symptoms and signs

Answer 8

Symptoms
cough: often worse at night
dyspnoea
‘wheeze’, ‘chest tightness’

Signs
expiratory wheeze on auscultation
reduced peak expiratory flow rate (PEFR)

Question 9

spirometry results in asthma

Answer 9

Typical results in asthma
FEV1 - significantly reduced
FVC - normal
FEV1% (FEV1/FVC) < 70%

Question 10

drugs used in asthma management

Answer 10

SABA - salbutamol - 1st line (blue inhaler)
- relaxes smooth muscle in airways

inhaled corticoseroids - fluticasone, beclometasone, dipropionate - ‘preventer’ taken daily, side effects oral candidiasis

LABA - taken daily,

leukotriene receptor - monteleukast

pts on SABA and ICS whose asthma is poorly controlled should be given leukotriene receptor agonist

MART (maintenance and reliever) - ICS and LABA combination

Question 11

asthma diagnosis in children

Answer 11

<5 - use clinical judgement
5-16 - spirometry with bronchodilator reversibility test (BDR)
FeNO test - if normal spirometry or obstructive spirometry with -ve BDR test
>17 - rule out occupational asthma
spirometry with BDR
FeNO test

Question 12

how to do spirometry and BDR

Answer 12

do a relaxed breath
take deep breath and breathe out as fast and hard for as long as you can
for BDR repeat after taking bronchodilators

Question 13

spirometry results interpretation

Answer 13

FVC normal, FEV1 and FEV1/FVC low - obstruction
FVC and FEV1 low, FEV1/FVC normal - restriction
all 3 low - mixed
FVC/FEV1 <70% - obstructive
reversibility testing
adults - +ve test is FEV1 improvement by 12% or more and vol increase of 200ml
children - +ve test FEV1 improvement of 12% or more

Question 14

types of asthma

Answer 14

Allergic asthma: Caused by allergens such as dust mites, mold, pollen, and pet dander
Nonallergic asthma: Caused by non-allergic triggers such as cold air, infections, household chemicals, and tobacco smoke
Exercise-induced asthma: Occurs during physical activity, especially when the air is dry
Cough-variant asthma: Characterized by a chronic cough, though other asthma symptoms like wheezing and shortness of breath may also occur
Nocturnal asthma: Asthma symptoms that wake you up at night, possibly due to changes in breathing patterns or hormones
Occupational asthma: Caused by inhaling allergens, chemicals, and irritants in the workplace
Eosinophilic asthma: Caused by high levels of eosinophils in the airways