Asthma

Question 1

What are proven risk factors for asthma?

Answer 1

Atopy - inherited tendency to IgE. May be contributing triggers i.e.exercise, pollen, food, drugs etc
Occupation - bakers at most risk because grains release wheat proteins and grain mites. Also lab animals, isocyanates, crustaceans.
Smoking - maternal smoking during pregnancy further increases risk. Also grandmother effect.

Question 2

What are the possible risk factors for asthma?

Answer 2

Diet - vitamin D and PUFA help reduce risk
Obesity - airway hyperactivity and pro inflammation
Microbial diversity - helps prevent asthma
Indoor pollution - use of chemicals

Question 3

What are the 3 stages in the diagnosis of asthma?

Answer 3

History (most important)
Variable symptoms
Examination

Question 4

What do you have to look out for in the history when diagnosing asthma?

Answer 4

Recurrent symptoms
Variability of symptoms
Recorded observation of wheeze
Personal history of atopy
Record of variable FEV1 or Peak Expiratory Flow

Question 5

When diagnosing asthma, what do you have to look out for in the variability of symptoms?

Answer 5

Triggers i.e. exercise, food, pollen, drugs, URTI’s, pets, chemicals, aspirin etc
Daily variation - morning/nocturnal
Weekly variation - occupation
Annual variation - seasonal (environment)

Question 6

Examination is usually unhelpful in the clinic, however what can be observed to help with the diagnosis?

Answer 6

Hyperexpanded chest
Breathlessness on exertion
Polyphonic wheeze

Question 7

On examination, what things may be found which would indicate that its NOT asthma?
- also what are the differential diagnosis for these findings on examination?

Answer 7

Cervical lymphadenopathy, stridor, clubbing, asymetrical expansion, crepitations and dull percussion tone

• this could indicate cystic fibrosis, left ventricular failure, alveolitis, or bronchiectasis

Question 8

State useful investigations for the diagnosis of asthma.

Answer 8

Chest x ray - (no effusion, collapse, opacities, interstitial change)
Skin prick test (atopy)
Full blood count
Total and specific IgE (atopy)

Question 9

On diagnosis, when the useful investigations have been carried out and it is definitely not asthma, what other tests can be carried out to help in the differential diagnosis?

Answer 9

Full pulmonary function testing:
Gas trapping - lung volumes (RV/TLC < 30%)
Carbon monoxide gas transfer - (TLCO and KCO)

Reversibility to bronchodilator and corticosteroids

Question 10

What are the main symptoms of asthma?

Answer 10

Wheeze, breathlessness, cough and tight chest

Question 11

what does that acronym CHARPPS stand for?

Answer 11

Chest sounds
Heart rate
Ability to speak
Respiratory rate
Peak flow
Partial pressure of 02
Saturation

Question 12

What 2 drugs can trigger an Athsma attack?

Answer 12

Beta blockers

Aspirin

Question 13

What 4 things are taken into account to help predict average Spirometry values?

Answer 13

Age
Race
Gender
Height

Question 14

What is Spiro entry like in mild moderate Athsma?

Answer 14

It is usually normal

It is only obstructed in severe Athsma/Athsma attack

Question 15

In asthma, is the FEV1 normal or reduced?
Is the FVC normal or reduced?
Is the FEV1/FVC normal, reduced or increased?

Answer 15

FEV is normal but can be reduced
FVC is usually normal but can be reduced in advanced disease
FEV1/FVC normal or reduced

Question 16

what type of hypersensitivity reaction is asthma?

Answer 16

type 1

Question 17

describe the pathophysiology of how an antigen can trigger an asthmatic response.

Answer 17

specific IgE triggers mast cell degranulation which trigger the activation of chemotactic factors and spasmogens