Asthma

Question 1

Increased levels of which cells are found in asthma?

Answer 1

Mast cells (in epithelium, smooth muscle, mucous glands)
Eosinophils (in bronchial wall & secretions )
Lymphocytes & Dendritic cells (in mucous membrane)

Question 2

What are the symptoms of asthma?

Answer 2

Episodic signs and symptoms
- dyspnoea
- non-productive cough (often nocturnal)
- triggers (e.g. cold air, aerosols)
- associated atopy (rhinitis, conjunctivitis, eczema)
Family History

Question 3

Signs in examination of asthma

Answer 3

Tachypnoea 
Audible wheeze 
Hyper inflated chest 
Hyperesonant on percussion 
Decreased air entry

Question 4

Investigations for asthma

Answer 4

Peak flow (decreased)
Spirometry (decreased FEV, FVC & FVC/FEV)
Exercise tests
Histamine/allergen inhalation - provacation
Reversibility to inhaled salbutamol

Question 5

Step 1 of asthma management

Answer 5

SABA when required

e.g. Salbutamol

Question 6

When do you step up to step 2 in asthma treatment?

Answer 6

When using SAB more than once daily or nighttime symptoms

Question 7

Step 2 of asthma management

Answer 7

Add standard dose inhaled steroid

e.g. Beclomethasone

Question 8

Step 3 of asthma management

Answer 8

Add LABA (e.g. Salmetarol) 
If adequate but still not controlled increase beclomethasone dose 
If LABA has no effect stop it and review diagnosis

Leukotriene receptor antagonist or oral theophylline may be tried

Question 9

Step 4 of asthma management

Answer 9

Consider trials of:
- beclomethasone up to 2000ug/day
- Modified release oral theophylline 
- modified release oral B2 agonist 
- Oral leukotriene receptor 
(Alongside previous therapy

Question 10

Step 5 of asthma management

Answer 10

Add regular oral prednisolone (low as possible)
Continue with high dose inhaled steroid
Refer to asthma clinic

Question 11

Define severe asthma attack

Answer 11

Inability to complete sentences
pulse > 100bpm
RR > 25/min
PEF 35 - 50% predicted

Question 12

Define life threatening asthma attack

Answer 12

Silent chest 
Confusion 
Exhaustion 
Cyanosis 
Bradycardia 
PEF >33% predicted

Question 13

Acute management of asthma

Answer 13

O - oxygen 100% non rebreather mask
S - salbutamol 5mg nebulised
H - hydrocortisone 100mg IV or prednisolone 40-50mg PO
I - ipratropium 0.5mg nebulised
T - theophylline IV or Aminophylline IV
M - Magnesium Sulphate 1.2 - 2g IV over 20 mins
E - escalate (anaesthetist)

Question 14

What are the pathological stages of asthma?

Answer 14

Genetic predisposition + trigger
Inflammation 
Mucus hypersecretion 
Airway remodelling 
Muscle hyperactivity