Asthma

Question 1

what is the prevalence of asthma in the general population?

Answer 1

8%

Question 2

what are the 3 factors contributing to airway narrowing in asthma?

Answer 2

• bronchial muscle contraction
• mucosal swelling/inflammation
• increased mucus production

Question 3

what is the process that causes mucosal swelling/inflammation in asthma?

Answer 3

Mast cell and basophil degranulation resulting in the release of inflammatory mediators

Question 4

What is an extrinsic cause of asthma? Give examples

Answer 4

When a definite cause is found, most common examples are in atopy; triggers include dust, pollen, animals, exercise, smoking, NSAIDS, beta-blockers

Question 5

What does an intrinsic cause of asthma mean?

Answer 5

There is no external trigger found

Question 6

Which part of which gene controls IgE synthesis

Answer 6

PHF11 on Ch2

Question 7

Name 7 symptoms of asthma

Answer 7

Dyspnoea
Wheeze
Chest tightness
Sputum production
Nocturnal cough
Diurnal variation
Disturbed sleep

Question 8

Name 7 signs of asthma

Answer 8

Tachypnoea
Hyperinflated chest
Hyper-resonant chest percussion
Diminished air entry
Prolonged expiration
Increased RR

Question 9

Other than symptoms, what factors indicate diagnosis?

Answer 9

FH, widespread wheeze, improvement with therapy, peripheral eosinophilia, atopy

Question 10

Which factors make diagnosis less likely?

Answer 10

lack of wheeze, normal chest exam, voice disturbance, symptoms with colds only, significant smoking history + cardiac disease.

Question 11

What are DDx for asthma?

Answer 11

COPD
pulmonary oedema
PE
Bronchiectasis
Foreign object
Bronchiolitis
Pneumothorax

Question 12

When should PEFR be taken at home and work?

Answer 12

When an occupational trigger is suspected

Question 13

Is peak flow more useful for diagnosis or monitoring?

Answer 13

Monitoring

Question 14

What does spirometry measure?

Answer 14

The presence, severity and reversibility of airway obstruction

Question 15

How low is an FEV1 to indicate obstruction and reversibility?

Answer 15

(FEV1:FVC=) <0.7

Question 16

Name 5 possible investigations?

Answer 16

Spirometry
Peak flow
Skin prick test
CXR
FBC

Question 17

What 8 factors define control of asthma?

Answer 17

• no asthma attacks
• no daytime symptoms
• no night time awakening due to asthma
• no exacerbations
• no limitations on activity
• normal lung function
• minimal side effects from medication

Question 18

What 4 changes in symptoms would each require a step up of treatment?

Answer 18

• using SABA 3 times or more in a week
• symptoms 3+ times a week
• Exacerbation in the last 2 year
• waking up one night a week

Question 19

Which meds should be avoided in asthma?

Answer 19

NSAIDS, beta blockers

Question 20

Name the 5 steps of asthma treatment for adults

Answer 20

1. start a SABA as required
2. Add inhaled cotricosteroid 400 micrograms a day
3. Add an inhaled LABA and assess LABA affect- increase dose inhaled corticosteroid if required (800 micrograms)
4. consider increasing corticosteroids up to 2,000 a day. Add either leukotriene receptor antagonist. SR theophylline, b agonist tablet
5. introduce daily steroid- lowest dose , refer to specialist

Question 21

Name the 5 steps of asthma treatment for children aged 5-12.

Answer 21

1. start a SABA as required
2. Add inhaled corticosteroid 200 micrograms
3. add laba and reasess- increase corticosteroid to 400 micrograms if required
4. increase inhaled corticosteroid to 8000 micrograms per day
5. use steroid tablet and refer to respiratory paediatrician

Question 22

Name the 5 steps of asthma treatment for children aged 0-5.

Answer 22

1. start SABA as required
2. add inhaled corticosteroid: 200-400 micrograms or a leukotriene agonist if inhaled corticosteroid cannot be used
3. add whichever not added in step 2. If under the age of 2, skip to step 4.
4. refer to respiratory paediatrician

Question 23

Name a SABA, LABA, inhaled corticosteroid and oral corticosteroid

Answer 23

salbutamol
salmetrol
beclomethasone dipropronate, budesonide
prednisolone