Asthma

Question 1

define asthma

Answer 1

chronic inflammatory airway disease characterised by:

• reversible airway obstruction
• airway hyper-responsiveness
• bronchial inflammation

Question 2

risk factors for asthma

Answer 2

genetic:
- family history
- atopy ( tendency for t lymphocytes to drive production of IgE on exposure of allergens)

environmental:
- pollen, house dust mites, cats, viral respiratory infections

Question 3

epidemiology of asthma

Answer 3

10% children, 5% adults, prevalence increasing

Question 4

presenting symptoms of asthma

+ precipitating factors

Answer 4

episodic history
wheeze
breathlessness
cough (worse in morning and night)

factors:
- cold, viral infection
- drugs (NSAIDs, B-blockers)
- exercise
- emotions

Question 5

signs of asthma

Answer 5

tachypnoea
use of accessory muscles 
prolonged expiratory phase 
hyper inflated chest 
polyphonic wheeze

Question 6

signs of severe attack

Answer 6

pefr <50% predicted
pulse >110
RR >25
inability to complete sentences

Question 7

life threatening attack

Answer 7

pefr <33% 
silent chest
cyanosis 
bradycardia
hypotension 
confusion 
coma

Question 8

acute investigations for asthma

Answer 8

peak flow, pulse oximetry, abg, cxr (exclude other causes e.g. pneumonia/pneumothorax), fbc (wbc raised if infective exacerbation), crp, u+e, blood and sputum cultures

Question 9

chronic investigations

Answer 9

peak flow
pulmonary function test
bloods (eosinophils, IgE level, aspergillum antibodies)
skin prick test ( help identify allergens)

Question 10

acute management plan

Answer 10

1. ABCDE, resus, monitor o2, abg and pefr
2. high flow 02
3. salbutamol nebuliser
4. ipratropium bromide (antimuscarinic)
5. steroid therapy (iv hydrocortisone, oral prednisolone)
6. consider slow iv aminophylline infusion
7. consider iv magnesium sulphate
8. anaesthetic may help if patient is getting exhausted
9. treat underlying cause ( e.g. infection) - abx
10. monitor electrolytes closely as bronchodilators and aminophylline cause drop in k+

Question 11

chronic management

Answer 11

1. inhaled short acting b2 agonist
2. 1+ regular inhaled low dose steroids
3. 2 + long acting b2 agonist
4. increase inhaled steroid dose
5. regular oral dose steroids, specialist care

Question 12

possible complications of asthma

Answer 12

growth retardation 
chest wall deformity (pigeon chest) 
recurrent infections 
pneumothorax 
rest failure 
death

Question 13

prognosis

Answer 13

children improve as they get older

adult onset asthma usually chronic