Asthma

Question 1

Define asthma

Answer 1

It is the chronic airway inflammation and increased airway hypersensitivity leading to wheeze, cough, chest tightness and SOB

The airflow obstruction in asthma is variable but reversible with treatment

Question 2

Common allergens of asthma

Answer 2

house dust mites, cats, dogs, cockroaches and fungi

Some occupations too

Question 3

What are the 3 factors in asthma that contribute to airway narrowing

Answer 3

Increased mucus production

Bronchial muscle contraction

Mucosal swelling/inflammation

Question 4

Clinical features of asthma

Answer 4

Typical symptoms

recurrent wheezing, chest tightness, SOB, and cough

Symptoms are worse in the morning (diurnal variation)

Symptoms can disturb sleep (cough and wheeze mainly)

Question 5

Precipitants of asthma

Answer 5

Cold air

Exercise

Allergen exposure

Viral respiratory tract infection

Drugs (B-blockers, aspirin, and NSAIDs)

Question 6

How to investigate acute asthma

Answer 6

PEFR

Sputum culture

FBC

U&E

CRP

Blood cultures

ABG

CXR - exclude infection or pneumothorax

Question 7

What to do in a Hx if patient likes his exercise in asthma

Answer 7

How long can you exercise for

Question 8

What to do to assess diurnal variation in asthma

Answer 8

Ask for peak flow meter morning readings and keep a diary

Question 9

What is an important thing to ask in an asthma history

Answer 9

Atopy:

Eczema, hayfever, Fx

are they affecting your ADL?

Question 10

What more about occupation you want to know in an asthma history

Answer 10

Is it affecting your job

How many days you skipped

Is it job related?

Question 11

What would you look for in an ABG in asthma

Answer 11

If PaCO2 is normal or decreased transfer to HDU or ITU

Also if pH <7.10 warrants ICU admision

Question 12

How to investigate chronic asthma

Answer 12

PEF monotiring

Spirometry - 15% improvement after Rx

CXR

Skin prick test may help identify allergen

Question 13

Medical management of asthma

Answer 13

Patient education

everyone gets short acting beta 2 agonists (Salbutamol)

Step 1 (reg Preventer) - Low dose ICS

Step 2 (initial add on) add inh LABA to step1 (usually as comb inhaler)

step 3 (additional add on) - assess LABA benefit. No, stop and incrase ICS dose. benefit continue LABA and ICS med dose. benefit but not adequate try LTRA, SR theophyline, LAMA

Step 4 (High dose) - Max dose ICS, consider leukotriene receptor antagonists (LTRA), theophyllines or slow-release β2-agonists tablet, LAMA

Step 5 - Predinosolone, consider other treatments to avoid oral steroid

Question 14

What you should be aiming when prescribing predinisolone for asthma

Answer 14

Give lowest amount possible

Question 15

What is step down therapy

Answer 15

Steroids need to be titrated down until minimal dose reached that control asthma

Question 16

Differential diagnosis of asthma

Answer 16

Pulmonary oedema

COPD (may co-exist)

Large airway obstruction (tumour /foreign body)

superior venacava (SVC) obstruction - wheeze/SOB not episodic

pneumothorax

PE

Question 17

Management of acute asthma

Answer 17

O SHIT

Oxygen

Salbutamol

Hydrocortisone IV or oral predinisolone

Ipratropium

Theophyline

Question 18

Acute Severe asthma attack

Answer 18

any one of:

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RR >25

HR >110

Peak expiratory flow (PEF) 33-50% of predicted

Question 19

life-threatening asthma attack

Answer 19

any one of:

PEF <30%

<92% sats

pO2 <8 kPa

normal paCO2 (4.6 - 6.9 kPa)

silent chest

poor respiratory effort

arrhythmia

exhaustion

cyanosis

hypotension

confusion

ABG

Question 20

Moderate asthma attack

Answer 20

increasing symptoms

PEF >50-75%

no features of acute severe asthma

Question 21

near fatal asthma attack

Answer 21

raised PaCO2 and or requiring mechanical ventilation