Asthma

Question 1

How does it develop

Answer 1

Typer 1 hypersensitivity
1- mast cells degranulate as a result of IGE, chemicals, drugs
2- chemotactic factors cause the release of inflammatory mediators e.g. histamine, lysosomal enzymes microthrombi
3- Spasmogens released e.g. histamine cause smooth muscle of bronchioles to contract
4- hyper reactivity of bronchioles, release of thick mucus, inflammation, epithelial damage

Question 2

investigation

Answer 2

Spirometry: 
-reduced FEV1
-possible reduced FVC
-decrease FEV1/FVC <70%
Beta agonist response 
ICS response 
Test for ATOPY/EOSONOPHILIA 
PEFR response: twice a day for 2 weeks, shows variability
Prick-test 
FBC- eosonophilia count 
Exhaled Iron nitride 
IgE count

Question 3

Signs

Answer 3

wheezing on auscultation

Eczema

Question 4

symptoms

Answer 4

Chest tightness 
SOB 
wheeze
cough- dry,paroxysmal 
Variation

Question 5

preventative treatment in adults

Answer 5

ICS
ICS + LABA
ICS+ LABA + LRTA - Medium dose ICS + LABA
ICS + LABA + LTRA + 4th drug or ICS to high dose
High dose ICS + low dose steroid

Question 6

MDI spacers

Answer 6

increase delivery of drug to lungs from 5% to 20%
if shake before inhale : increases delivery x 2
if wash once a month: increase delivery x2

Question 7

Non pharmacological treatment

Answer 7

weight control
remove of tobacco exposure
removal of allergens 
flu vaccination 
nutritional assessment

Question 8

Risk factors?

Answer 8

DEFINITE
-Genetic: 
Inherited response to allergens 
Inherited atopy- especially maternal 
associated with allergen genes: IL-4, IL-5, IgE
associated with airway genes: ADAM33
-Smoking : maternal smoking
decreases FEV1
increases chances of Wheeze
increases airway reactivity
-Occupation
POSSIBLE:
-Diet:
vitamin D
n-3 polyunsaturated fatty acids decrease 
n-6 polyunsaturated fatty acids increase 
-obesity
-Reduced exposure to microbes 
-Indoor Pollution 
-Environmental factors e.g. plant pollen, pets

Question 9

preventative treatment in children

Answer 9

-beta agonist- used three times a week or more/ shows nocturnal symptoms
-very Low dose ICS
-very low dose ICS with LABA in over 5s, LTRA in under 5s
-low dose ICS + LABA or very low dose ICS+ LABA +LTRA
or low dose ICS
-medium dose ICS or add 4th drug- SR theophylline
-steroid tablet + medium dose ICS

Question 10

How is treatment in children different?

Answer 10

• max dose of ICS is 800mg
• no ora beta agonist
• No LAMA

Question 11

Signs of moderate acute asthma

Answer 11

• problems with speech
• HR>110
• RR> 25
• Sa02>92%
• Pa02>8 Kpa
• PEFR 33-50%

Question 12

Signs of life threatening asthma?

Answer 12

• grunting
• HR>130
• impaired consciousness
• hypoventilation
• cyanosis
• PEFR<33%

Question 13

Signs of fatal asthma?

Answer 13

increase in PaCO2

Question 14

Treatment of mild acute asthma

Answer 14

SABA via inhaler

Question 15

Treatment of moderate acute asthma?

Answer 15

SABA via nebuliser

Question 16

Treatment of severe acute asthma?

Answer 16

IV salbutamol 
IV magnesium 
IV Aminophylline 
IV hydrocortisone 
Intubate/ventilate

Question 17

Advantages of inhalers

Answer 17

• small dose drug- can be controlled
• delivered to target organ
• reduces systemic abnormalities

Question 18

Specialist therapy for Asthma?

Answer 18

• anti-IgE
• anti-interleukine 5
• Bronchial thermoplastic

Question 19

main ICS

Answer 19

fluticasone

Question 20

Definition of Asthma?

Answer 20

Obstructive lung disease due to inflammatory response to a stimuli which leads to generalised narrowing of the small airways.
Severity can change either spontaneously or in response therapy

Question 21

Advantages of using an inhaler of a nebuliser

Answer 21

• portable
• cheaper
• safer