Asthma

Question 1

What percentage of children have asthma?

Answer 1

10-15%

Question 2

In children is asthma more common in boys or girls?

Answer 2

Boys

Question 3

What percentage of adults have asthma?

Answer 3

5-10%

Question 4

In adults is asthma more common in men or women?

Answer 4

Women

Question 5

Define asthma

Answer 5

An increased responsiveness of the trachea and bronchi to various stimuli and manifests by a widespread narrowing of the airway that changes in severity either spontaneously or as a result of therapy

Question 6

What is atop?

Answer 6

An IgE response to an allergen such as food or pollen

Question 7

Which type of atopy is more influential?

Answer 7

Maternal atopy

Question 8

Which genes are associated with genetic atopy?

Answer 8

ADAM 33 - airway genes

Immune response genes

Question 9

What are the proven risk factors for asthma?

Answer 9

Genetic atopy
Occupation
Smoking

Question 10

Why do airways narrow in asthma?

Answer 10

Because the airway itself thickens as well as a build up of mucous and cellular debris

Question 11

What are the possible risk factors for asthma?

Answer 11

Obesity
Diet
Reduced exposure to microbes/microbial products
Chemical household products - indoor pollution

Question 12

Which occupation has the highest rates of asthma?

Answer 12

Bakers because of the wheat protein and the grain mites in the grains

Question 13

What are the problems that are risk factors for occupational asthma?

Answer 13

Isocyanates
Rosin  
Lab animals - rodent urine proteins
Grains - wheat proteins, grain mites
Enzymes - subtilisn, amylase 
Drugs - antibiotics, salbutamol 
Crustaceans

Question 14

What is the grandmother effect with smoking?

Answer 14

The oocytes in the baby of a smoker are modified by the smoking so the baby will have children that can be effected by their grandmothers smoking

Question 15

What are some environmental allergens?

Answer 15

House dust mites
Cats
Grass Pollen

Question 16

What are the symptoms of asthma?

Answer 16

Wheeze 
Dyspnoea 
Chest tightness
Paroxysmal coughing, usually dry 
Sputum

Question 17

What is dyspnoea?

Answer 17

Shortness of breath

Question 18

What is paroxysmal coughing?

Answer 18

A coughing fit

Question 19

What is the key characteristic of asthma in adults?

Answer 19

Evidence of variable symptoms coming at different times

Question 20

What signs can help rule out asthma?

Answer 20

Clubbing 
Stridor 
Asymmetrical expansion 
Dull percussion note
Crepitations (crackling or rattling sound)

Question 21

What are the signs to look for in asthma?

Answer 21

Hyper-expanded chest
Tachypnoea (abnormally rapid breathing)
Polyphonic wheezes
Hyper-resonant percussion notes

Question 22

How can variable airflow obstruction be checked?

Answer 22

Using a peak flow chart for a period of time

Question 23

For children what is the rule to follow for diagnosing asthma?

Answer 23

No wheeze, no asthma

Question 24

What are the drugs used to treat asthma?

Answer 24

Bronchodilators

Question 25

What are the main types of bronchodilators?

Answer 25

Long/Short acting beta-2 agonists Long/Short acting antimuscarinics Long/Short acting theophylines

Question 26

What drugs shouldn't be used to treat asthma?

Answer 26

``` Beta blockers NSAIDS Aspirin Sedatives Strong opiates ```

Question 27

What is the difference in drug treatment between chronic asthma and an acute asthma attack?

Answer 27

The delivery of the drug

Question 28

What are the different types of inhalers?

Answer 28

Meter dose inhaler (pMDI) pMDI with spacer Dry powder inhaler (DPI)

Question 29

Give examples of short acting Beta-2 agonists

Answer 29

Salbutamol | Terbutaline

Question 30

What do corticosteroids do?

Answer 30

To reduce inflammation and suppress the immune system

Question 31

What are corticosteroids used for in the treatment of asthma?

Answer 31

They are preventers that are taken regularly to manage symptoms of asthma

Question 32

Name the different types of inhaled corticosteroids available

Answer 32

``` Beclomethasone Budesonide Fluticasone Ciclesonide Mometasone ```

Question 33

When do you start ICS?

Answer 33

Using inhaled β2 agonist (“Reliever”) x3/week or more Waking one night a week or more due to asthma Requiring oral steroid for an exacerbation in the past 2 years Symptomatic x3/week or more

Question 34

What are common side effects of inhaled long term steroids?

Answer 34

Dysphonia | Oropharyngeal candidiasis

Question 35

What is the progression when treating asthma?

Answer 35

1. Short acting beta-2 agonist 2. Low dose ICS 3. Low dose ICS + LABA 4. Increase ICS dose and possibly add another therapy 5. Increase ICS to high dose and possibly add 4th drug 6. Use daily steroids and high dose of ICS

Question 36

Name ICS + LABA medication

Answer 36

``` Fostair Symbicort DuoResp SpiroMax Flutiform Seretide Relvar Ellipta ```

Question 37

What is a LTRA?

Answer 37

Leukotriene receptor antagonist

Question 38

What are the two types of LTRAs used?

Answer 38

Montelukast | Zafirlukast

Question 39

What is theophylline?

Answer 39

Non-specific phosphodiesterase inhibitor and adenosine receptor antagonist

Question 40

Name a LAMA?

Answer 40

Tiotropium bromide

Question 41

What is the main long term oral steroid used?

Answer 41

Prednisolone

Question 42

How should long term oral steroids be prescribed?

Answer 42

Aim for the lowest oral dose that controls symptoms

Question 43

What can be given to patients who have are on long term steroids and have high IgE levels?

Answer 43

Omalizumab - anti-IgE

Question 44

What can be given when there is poor asthma control with blood eosinophilia?

Answer 44

Mepolizumab - anti-interleukin-5

Question 45

What immunosuppressive drugs can be used as a last resort?

Answer 45

Methotrexate Ciclosporin Oral Gold

Question 46

What are the non-pharmacological treatments for asthma?

Answer 46

``` Patient Education and Self management plans Inhaler technique Smoking cessation Flu/Pneumococcal vaccinations Allergen avoidance Bronchial thermoplasty Dealing with co-morbidities ```

Question 47

How is control of asthma measured in children?

Answer 47

Short acting beta-2 agonist / week Absence school/nursery Nocturnal symptoms/week Excertional symptoms/week

Question 48

What is the difference in drug treatment between children and adults?

Answer 48

In children the maximum dose of ICS is 800 micrograms, no oral B2 tablets and LTRA is the first line preventer in under 5s

Question 49

What is the progression when treating asthma in children?

Answer 49

1. Short acting B2 agonist as required 2. Very low dose ICS or LTRA <5 3. Add LABA >5 or add LTRA <5 4. Increase ICS to low dose or trial other therapy 5. Increase ICS to medium dose or add 4th drug 6. Daily steroid tablet in lowest dose and consider other treatments

Question 50

With children when should you step up treatment?

Answer 50

Using reliever 3x/week or more | Symptomatic 3x/week or more or waking up one night a week

Question 51

Which type of ICS should be avoided?

Answer 51

Fluticasone

Question 52

What has to be done when using LABA?

Answer 52

Do not use without ICS | Use a fixed dose inhaler

Question 53

What should always be used with an inhaler?

Answer 53

A spacer

Question 54

How should steroids be used in asthma treatment?

Answer 54

Chronic - Inhaled steroids Acute - Oral steroids

Question 55

Who can use dry powder devices?

Answer 55

They are licence for over 5s but under 8s cannot use them