Asthma

Question 1

What is asthma always associated with?

Answer 1

A wheeze

Question 2

Why does a wheeze occur with asthma?

Answer 2

Bronchoconstriction, airwall thickening and luminal secretions.

Question 3

How can you tell that the airway obstruction is asthma and not something else?

Answer 3

it should be a variable obstruction, that responds to treatment.

Question 4

How does paediatric asthma differ to adult asthma?

Answer 4

what gender its common differs (boys/women)
Doesn’t tend to be occupation linked
Can be more severe in children

Question 5

How common is asthma?

Answer 5

Very - 1,000,000 in UK

100,000 in scotland.

Question 6

Is the prevalence of paediatric asthma increasing or decreasing?

Answer 6

increasing

Question 7

Asthma is caused by ‘multiple hits’. Name some of these hits.

Answer 7

Infant onset, childhood onset, adult onset, excertional, occupational, genes, abnormal lungs, later exposure to rhinovirus, exercise and smoking.

Question 8

How can asthma be considered so inconsistent?

Answer 8

varies in severity, symptoms, onset ages, triggers.

Question 9

Why is childhood asthma so difficult to diagnose?

Answer 9

patient may not be wheezing at the time,
cannot use stethoscope,
spirometry insignificant (varying results in all children without asthma),
Rattle/stridor mistaken for wheeze. (55% is not really asthma)

Question 10

What is an isolated cough more likely to be?

Answer 10

bronchitis (wet cough), habitual cough

Question 11

Is there a lower age limit on asthma?

Answer 11

No - but under 18 months its more likely an infection.

Question 12

How do you treat asthma?

Answer 12

Inhaled corticosteroids

salbutamol

Question 13

Whats atopy? (doesnt cause asthma - but is linked)

Answer 13

tendency to be ‘hyper allergic’

Question 14

Why may a child’s wheeze be wise than an adults wheeze?

Answer 14

They have smaller airways anyway

Question 15

whats the difference between asthma and viral induced wheeze?

Answer 15

Completely different conditions but may present the same symptoms and should both be treated.

Question 16

What could be misdiagnosed as a wheeze?

Answer 16

Rattle, steror

Question 17

What are the symptoms of bronchitis?

Answer 17

loose, rattly cough, noisy breathing, post tussive vomiting (vomiting caused by cough)
NO WHEEZE

Question 18

what are the symptoms of pertussis?

Answer 18

Whooping cough
Coughing fits
Vomiting
Colour change
Petechiae (wee purple spots)

Question 19

What is the definition of asthma?

Answer 19

Increased responsiveness of the trachea and bronchi to various stimulus - more likely in the presence of an irritant. Widespread narrowing that changes in severity either spontaneously or as the result of therapy. Varying symptoms
Inflammation mediated by the immune system

Question 20

What are some things that can trigger asthma?

Answer 20

Exercise, cold air, smoke, food, emotion, menstruation.

Question 21

Are hospital rates of adult asthma increasing or decreasing?

Answer 21

Increasing

Question 22

name some risk factors for asthma. Including some that are not proven.

Answer 22

genetic - atopy
occupation
smoking
(maybe - diet, obesity, less exposure to microbes, indoor pollution)

Question 23

what other disorders are linked with asthma, secondary to the same process of hyper allergic IgE response?

Answer 23

Eczema, food allergy

Question 24

How much more influential is maternal atopy than paternal atopy?

Answer 24

3x more influential .

Question 25

How does a mother smoking during pregnancy affects the childs chances of asthma?

Answer 25

will decrease the FEV1 and increase the risk of asthma

Can also modify oocytes

Question 26

what kind of diet is thought to increase the risk of cancer?

Answer 26

Less vitamins and more oily fish

Question 27

How do you diagnose asthma?

Answer 27

Make sure there isn’t another cause.

See if it is obstructive, and responds to treatment.

Question 28

what other things could be mistaken for asthma?

Answer 28

Tumour, foreign body (would give you a lower FEV1)

Generalised airway obstruction - bronchiectasis,, bronchiolitis, cystic fibrosis

Question 29

what is bronchiectasis?

Answer 29

permanent enlargement of parts of the airway in the lungs

Question 30

What is bronchiolitis?

Answer 30

inflammation of the bronchioles.

Question 31

what is the FEV1 / FEV1/FCV predicted to be in asthma?

Answer 31

FEV1 < 80%
FEV1/FVC <70%
However they could be completely normal.

Question 32

what should we do next is we suspect asthma but the FEV1 / FEV1/FVC is normal?

Answer 32

See if theres any change over 2 weeks.

Then you could do a nitric oxide test - to see levels of nitric oxide in exhaled breath

Question 33

how does levels of NO in the exhaled breath of people with asthma - differ to the levels in peoples breath without asthma?

Answer 33

Much more in people who asthma

Question 34

what would a full pulmonary function test exclude?

Answer 34

COPD or emphysema

Question 35

what drugs does asthma also have an airway responsiveness too?

Answer 35

methacholine and histamine

reversible with B2 agonists or steroids.

Question 36

How do you test to see if asthma is occupational asthma?

Answer 36

see if the symptoms correspond to being at work (DUH)

make sure you get 2 pairs of exposed / unexposed serial peak flow readings (minimum)

Question 37

How could a chest X-ray help to diagnose asthma?

Answer 37

to discount any other reasons for the symptoms such as a collapsed lung.

Question 38

Can asthma cause a pneumothorax?

Answer 38

Yes - so can COPD and other respiratory disorders

Question 39

How could skin prick testing, IgE tests, and full blood test help diagnose asthma?

Answer 39

atopic testing - eosinophilia in bloods

all associated with asthma

Question 40

How do you diagnose acute severe asthma?

Answer 40

may not have symptoms
may have no ability to speak, grunting, heart rate, pulse rate, impaired conciseness, hyperventilating

Raised PaCo2