Asthma

Question 1

Definition

Answer 1

Asthma is an inflammatory condition causing reversible airway obstruction and symptoms of (all, or any one) cough, wheeze, chest tightness or breathlessness, symptoms respond to a Beta-2 agonist by 12% in FEV1/FVC

Question 2

Types of Asthma

Answer 2

• Extrinsic - childhood, hypersensitivity. May remit by teenage years. More likely to have increased IgE
• Intrinsic - develops in later life, less likely to be caused by an allergy, less likely to have increased IgE
• Occupational - relates to industrial/work place allergens (photocopier, baking, soldering, welding, spray painting)

Question 3

Common cause for exacerbation

Answer 3

80% viral infection

Question 4

Clinical presentation of asthma

Answer 4

• Wheeze
• Chest tightness
• Shortness of Breath
• Cough
• Deviated trachea (tension pneumothorax)
• Pulsus paradoxus (BP decreases >10mmHg with inspiration)

Question 5

Investigations for Asthma

Answer 5

• CXR - for severe attack: hyperinflation & to exclude pneumothorax
• ABG - for chronic patient

Pulmonary Function Tests

• Peak Expiratory Flow Rate (PEFR) - useful in showing the variable airflow limitation that characterises the disease
• Spirometry
  FEV1/FVC ratio < 70%, lower FEV1 and FVC near normal (obstructive problem)
• Response to bronchodilator of more than 12% improvements to FEV1 or PEFR

Question 6

Management of Asthma

Answer 6

Step 1 - SABA
Step 2 - Add low dose ICS
Step 3
- Increase ICS to medium
- OR Add LABA
- OR Switch to ICS-LABA FDC
Step 4
- Medium dose ICS + LABA
- OR increase ICS to high + LABA
- OR higher dose FDC

FDC = Fixed Dose Combination

Question 7

Acute Asthma Attack

Answer 7

Mild

• SABA - salbutamol (MDI/Neb)
• ICS - budesonide or fluticasone

Moderate

• ? O2
• SABA - salbutamol (MDI/Neb)
• ICS - budesonide or fluticasone

Severe

• O2
• SABA - salbutamol (Neb)
• Ipratropium bromide (neb)
• Oral prednisolone or hydrocortisone