Asthma

Question 1

What is the pathophysiology of asthma?

Answer 1

Airway inflammation mediated by the immune system

Widespread narrowing or airways and increased airway reactivity

Question 2

What are the 3 main risk factors for asthma?

Answer 2

Genetics
Occupation
Smoking

Question 3

How does genetics lead to asthma?

Answer 3

Atopy
Inherited tendency to IgE response to allergens
Personal/familial (esp maternal) strongest tendency

Question 4

What % of adult onset asthma cases are occupation related?

Answer 4

10-15%

Question 5

What are the strongest risk factors for asthma re smoking?

Answer 5

Maternal and grandmother smoking during pregnancy

Question 6

What are some environmental allergens that may trigger asthma?

Answer 6

House dust mite
Cat
Grass pollen

Question 7

What are the symptoms of asthma?

Answer 7

Wheeze 
SOB
Tight chest
Cough
Sputum

Question 8

What are some triggers for asthma?

Answer 8

Exercise
Cold air
Smoking
Perfume
Pets

Question 9

When is asthma typically at its worst?

Answer 9

Nocturnal and early morning

Question 10

How does occupational asthma vary weekly?

Answer 10

Better at weekends and holidays

Question 11

How does asthma vary annually?

Answer 11

Due to environmental antigens

Question 12

What are the symptoms of moderate acute asthma?

Answer 12

Able to speak and complete sentences
HR <110
Resp rate <25
Peak flow 50-75%
SpO2 >92%

Question 13

What are the symptoms of severe acute asthma?

Answer 13

Unable to speak and complete sentences
HR >110
Resp rate >25
Peak flow 33-50%
SpO2 >92%

Question 14

What are the symptoms of life threatening acute asthma?

Answer 14

Grunting
HR >130 or bradycardic
Hypoventilating
Altered concious level
Exhaustion
Arrythmia
Hypotension
Cyanosis
Silent chest
Poor resp effort
PEF <33% predicted
SpO2 <92%
PaO2 <8kPa

Question 15

What are the primary differences between asthma in children and adults?

Answer 15

In children, more common in boys. In adults, more common in women
Children often have more intermittent symptoms

Question 16

How is asthma controlled in an acute situation?

Answer 16

Oxygen
Salbutamol (nebuliser)
Prednisilone 40mg/hydrocortisone 100mg
Ipratripium (nebuliser)
Magnesium sulphate (IV) if no improvement

Question 17

What is the 1st step in asthma management?

Answer 17

Short acting B2 agonist

Salbutamol/terbutaline

Question 18

What is the 2nd step in asthma management?

Answer 18

Inhaled corticosteroids

Beclomethasone

Question 19

When is a patient upped from the 1st to 2nd step?

Answer 19

When using rescue medicine 3x weekly, symptomatic 3x weekly, or waking 1 night a week due to asthma

Question 20

What is the 3rd step in asthma management?

Answer 20

Long acting B2 agonist and inhaled corticosteroid

Fostair

Question 21

What is the 4th step in asthma management?

Answer 21

Inhaled long acting muscarinic antagonist

Leukotrine receptor antagonists

Question 22

What is the 5th step in asthma management?

Answer 22

Long term oral steroids

40-50mg prednisilone

Question 23

What are some of the side effects of long acting muscarinic antagonists?

Answer 23

GI upset
Dry mouth
headaches

Question 24

What are some of the side effects of inhaled corticosteroids?

Answer 24

Can cause oral candidiasis

Question 25

What is the multiunit theory of asthma?

Answer 25

Requires multiple hits and culminate in asthma
Genes
Inherently abnormal lungs
early onset atrophy
Later exposure

Question 26

How is childhood asthma diagnosed?

Answer 26

All in the history
Peak flow done but unhelpful (variable)
Wheeze
SOB at rest
Responds to treatment