Asthma

Question 1

Diagnosing asthma

Answer 1

First line spirometry:

FEV

Question 2

Pathology of asthma

Answer 2

A chronic inflammatory disease characterised by recurrent attacks of breathlessness and wheezing
Inflammatory cells infiltrate: eosinophils, lymphocytes, neutrophils
Mast cell activation, epithelial injury
Abnormal smooth muscle function and neovascularisation

Question 3

Smooth muscle dysfunction

Answer 3

Bronchoconstricrion
Bronchial hyperreactivity
Hyperplasia
Inflammatory mediator release
Use LABA

Question 4

Airway inflammation

Answer 4

Inflammatory cell infiltration/activation
Mucosal oedema
Cellular proliferation
Epithelial activation
Airway remodelling
Use ICS

Question 5

High probability of asthma

Answer 5

Cough
Wheeze
Worst at night
Exercise induced?
Family history
Widespread wheeze
Evidence of airway narrowing

Question 6

Low probability of asthma

Answer 6

Cough but no wheeze/SOB
Dizzy and lightheaded
No airway narrowing
Voice disturbances
Symptoms with cold only
Chronic productive cough
Smoking history
Cardiac disease

Question 7

Asthma control test

Answer 7

5 questions refer to past 4 weeks
Score 25: perfecto control
20-24: May be well controlled, give further advice

Question 8

Symbicort SMART

Answer 8

Use reliever as both maintenance and reliever

Ppl who respond to LABA but poor control or adults taking ICS alone

Question 9

Asthma personalised plan

Answer 9

How to recognise signs of worsening asthma
What to do in response
How to monitor response to treatment
Contact details for asthma nurse

Question 10

Difficult asthma

Answer 10

Step 4 or 5 plus one of the following:

• an event of life threatening sever asthma (within 10 years)
• maintenance oral steroids (>7.5mg pred for 6 months)
• 2 hospitalisations within 12 months (adherent to ICS)
• fixed airway obstruction

Question 11

Aim of therapy

Answer 11

No daytime symptoms
No night time weakening
No need for rescue medication 
No exacerbations
No limitations on QOL
Normal lung function
Minimal side effects from medicines

Question 12

Challenges of difficult to treat asthma

Answer 12

High rates of alternative/co-existing diagnosis
High rate of psychological co-morbidities
Poor adherence to treatment

Question 13

Airway remodelling

Answer 13

Airway walls thicken, more narrow, harder to breathe

Sever asthma/not managed well/frequent asthma attacks

Question 14

ACOS

Answer 14

Asthma and COPD overlap syndrome 
Poor lung function all the time and frequent asthma attacks
Over 40
Asthma for long time
Smoker

Question 15

SIMPLE

Answer 15

Stop smoking
Inhaler technique
Monitoring
Pharmacotherapy
Lifestyle
Education

Question 16

Bronchiectasis

Answer 16

Abnormal widening of airways
Extra mucus prone to infection
Need physio and antibiotics

Question 17

Sputum eosinophil count

Answer 17

Number is associated with asthma severity

Raised >2%= untreated

Question 18

Exhaled nitric oxide concentrations

Answer 18

ICS can reduce

Question 19

Pharmacological options to manage difficult to treat asthma

Answer 19

Anti IGE: omalizumab
TNFalpha: etanercept
Others: cyclosporin, methotrexate, gold, terbutaline injection (monitor HR)

Question 20

Anti IGE

Answer 20

Licensed step 4/5
FEV1 2 exacerbations
skin prick test positive to common aeroallergen
IgE more than 50 less than 700

Question 21

Problems with PICC line

Answer 21

Infection
Clots
Air in the line
Break or cut in the PICC

Question 22

Safety issues to discuss with steroid patients

Answer 22

Adrenal suppression/Cushings
Cataracts/glaucoma
GI
Increased susceptibility to infections
Myopathy/osteoporosis
Aggregation of epilepsy
Psychosis

Question 23

Lifestyle

Answer 23

Stay active
Lose weight
Smoking cessation
Importance of keeping reliever inhaler with them
Emergency contact details
Flu vaccine