ASTHMA

Question 1

What is asthma?

Answer 1

inflammation of the airways

Question 2

Which form of asthma can be severe and life threatening (acute or chronic)?

Answer 2

Acute asthma

Question 3

How common is asthma?

Answer 3

common

Question 4

What are the risk factors? (10)

Answer 4

1. atopy history
2. family history of atopy
3. environment
4. socio-economic deprivation
5. obesity
6. prematurity and low birth weight
7. viral infections in early childhood
8. smoking
9. maternal smoking
10. early exposure to broad spectrum antibiotics

Question 5

What causes asthma? (8)

Answer 5

1. cold air
2. exercise
3. emotions
4. allergens - house dust mite, pollen, fur
5. pets
6. carpets
7. feather pillows or duvet
8. paint sprays

Question 6

What are the symptoms? (5)

Answer 6

1. intermittent dyspnoea
2. wheeze
3. cough
4. sputum
5. diurnal variation

Question 7

What is diurnal variation?

Answer 7

a cycle to symptoms - peak flow low in the morning

Question 8

What are the signs? (6)

Answer 8

1. tachypnoea
2. wheeze
3. hyper inflated chest
4. hyperressonant percussion note
5. decreased air entry

Question 9

What types of wheezes are there? (2)

Answer 9

1. audible

2. polyphonic

Question 10

What are the signs of a severe asthma attack? (4)

Answer 10

1. inability to complete sentences
2. pulse > 110 bpm
3. RR> 25 breaths/min
4. PEF - decreased by 35-50%

Question 11

What are the signs of a life threatening attack? (6)

Answer 11

1. silent chest
2. confusion
3. exhaustion
4. cyanosis
5. bradycardia
6. PEF< 33%

Question 12

What is the sign of a fatal asthmatic attack?

Answer 12

increased PaCO2

Question 13

What are the differential diagnoses? (8)

Answer 13

1. pulmonary oedema
2. COPD
3. large airway obstruction
4. SVC obstruction
5. pneumothorax
6. PE
7. bronchiectasis
8. obliterative bronchiolitis

Question 14

Investigations of an acute asthma attack? (8)

Answer 14

1. PEF
2. Sputum culture
3. FBC
4. U&Es
5. CRP
6. blood culture
7. ABG
8. CXR

Question 15

What would the ABG results show in an acute attack of asthma and what is this known as (hypo or hyper-ventilation) ?

Answer 15

• normal/slightly high PaO2
• low PaCO2
• hyperventilation

Question 16

Why is a CXR done in an acute attack of asthma?

Answer 16

• to rule out infection

Question 17

What investigations are done in chronic asthma patients? (5)

Answer 17

1. PEF
2. spirometry
3. skin prick test
4. histamine or methacholine challenge
5. aspergillus serology

Question 18

What is the drug treatment? (5)

Answer 18

1. short acting beta-2-agonist - salbutamol
2. inhaled steroid - beclomethasone
3. long acting beta-2-agonist - salmetarol
4. leukotriene receptor (if all fails)
5. oral theophylline (if all fails)
6. prednisolone (last resort)