Asthma

Question 1

What is the difference between obstructive and restrictive lung disease?

Answer 1

Restrictive = cant inflate lungs normally

Obstructive = problem with the airways

Question 2

Define asthma

Answer 2

heterogeneous disease, usually characterised by chronic airway inflammation

defined by the history of respiratory symptoms such as wheeze, shortness of breath, chest tightness and cough that vary over time and in intensity, together with variable expiratory airflow limitation

Question 3

What are the symptoms of asthma?

Answer 3

Expiratory wheezing

Shortness of breath

Diff breathing

Cough

Chest tightness and cough that vary over time in their occurrence, frequency and intensity

Question 4

Describe the nature of the air flow obstruction in asthma

Answer 4

Mucosal oedema

Bronchoconstriction

Mucus plugging

Question 5

Describe, in outline, the pathophysiology of asthma

Answer 5

Airway inflam = Th2-driven/eosinophilic/non-eosinophilic/neutrophilic

Intermittent airflow obstruction = airway oedema, mucus hypersecretion, smooth muscle hyperplasia and remodelling

Bronchial hyper-responsiveness

Question 6

What is included in remodelling?

Answer 6

Smooth muscle hyperplasia

Hyperplasia of goblet cells

Thickened basement membrane

Question 7

Describe the major precipitating factors for asthmatic attacks

Answer 7

1) genetic susceptibility and gene-environment interactions
2) environmental risk=

Perinatal factors

Indoor/outdoor allergens

Smoking

Smoke

Obesity

Respiratory illness

Question 8

Describe the typical clinical presentations of asthma

Answer 8

More than one type of symptom (wheeze, shortness of breath, cough, chest tightness)

Symptoms often worse at night or in the early morning

Symptoms vary over time and in intensity

Symptoms are triggered by viral infections, exercise, allergen exposure, changes in weather, laughter, irritants such as car exhaust fumes, smoke, or strong smells

Question 9

Describe the tests used to assess the condition of a patient suspected of asthma

Answer 9

Bronchodilator reversibility testing

Spirometry = FEV1, FVC

Peak flow

Is spirometry normal = challenge test: give histamine try an induce airway hyperesponsiveness

Question 10

How can eosinophilic inflam be measured?

Answer 10

Peripheral blood eosinophil count (FBC)

Induced sputum (eosinophils, neutrophils)

FeNO (exhaled nitric oxide)

Question 11

Describe, in outline, the principles of treatment of asthma

Answer 11

(Reducing inflam) Steroids = inhaled budesonide, oral prednisolone

(Improving smooth muscle dysfunction) Beta 2 agonist = short-acting salbutamol, long-acting formoterol

Muscarinic antagonist

Oxygen therapy

Question 12

Outline the management of asthma

Answer 12

SIMPLE
Smoking cessation
Inhaler techniques
Monitoring
Pharmacotherapy
Lifestyle
Education

Question 13

Outline the red flag symptoms of asthma

Answer 13

Sputum changes in volume, colour, stickiness or thickness

Haemoptysis (blood in sputum)

Weight loss

Ankle swelling

Waking up twice or more at night being short of breath

Severe fatigue

Inability to speak sentences

Slurred speech

Severe shortness of breath

Night sweats

Finger clubbing

Question 14

Describe in outline how to recognise acute sever asthma

Answer 14

PEF 33-50%

Resp rate >25/min

HR >110/min

Inability to complete sentences in one breath

Question 15

Describe how to treat acute severe asthma

Answer 15

Oxygen, high flow

Nebulised salbutamol

Oral prednisolone

If not responding = add nebulised ipratropium bromide

Consider IV magnesium

Question 16

What often triggers asthma?

Answer 16

Viral infection