Asthma

Question 1

What causes airflow obstruction?

Answer 1

Bronchoconstriction

Bronchial secretions from bronchus and mucus plugs- due to inflammation

Bronchial wall oedema- inflammation of mucosal lining.

Question 2

Atopy

Answer 2

Tendency to develop allergies:

Forms IgG antibodies to allergens, that aren’t harmful- pollen, house dust.

Question 3

Risk factors for asthma

Answer 3

Genetics

Smoking

Obesity

Pollution

Occupation

Question 4

Symptoms of asthma

Answer 4

Cough
Wheeze
Breathlessness

Symptoms are worse at night 3-4am.
Also worse after exposure to allergens or infection.

Question 5

Investigations in asthma

Answer 5

CXR- could show hyperinflation, but is usually normal.

Blood count- increase in eosinophil.

Blood test- confirm a lot of allergies.

LFT- airflow obstruction.

Question 6

Pharmacological relievers for asthma

Answer 6

Beta-2 agonists

Theophylline

Anticholinergics

Question 7

Beta-2 agonist relievers for asthma

Answer 7

Salbutamol

Terbutaline

Question 8

Sodium cromoglycate

Answer 8

Non-steroidal anti-inflammatory drug.

Prevents asthma attacks

Question 9

Controllers/preventers for asthma

Answer 9

Inhaled corticosteroids

Long acting inhaled beta agonists.

Question 10

BTS/SIGN asthma guidelines steps

Answer 10

1. Inhaled short acting beta-2 agonist.
2. Added inhaled corticosteroid = micrograms a day for adult. Half the dose for children.
3. Add long acting beta-agonist.
4. Add any or all of: inhaled steriods up t 2000 micrograms, oral beta-2 agonist, leukotriene receptor antagonist, theophylline, cromone.
5. Add daily oral steriod

Question 11

Three key questions to assess the progression of asthma

Answer 11

1. Have you had difficulty sleeping because of asthma symptoms?
2. Have you had your usual asthma symptoms during the day?
3. Has your asthma interfered with your usual activities?

Question 12

Very specialised treatments for patients with tricky asthma

Answer 12

Monoclonal antibodies injections: omalizumab

Desensitisation to proven inhalant allergens.

Immunosuppressant therapies- like methotrexate

Bronchial thermoplasty

Question 13

Unintentional reasons for lack of treatment adherence

Answer 13

Patients misunderstood treatment.

Asthmatic may have poor inhaler technique.

Language barrier

Patient may forget due to stress

Question 14

Intentional reasons for lack of treatment adherence

Answer 14

Patients may be concerned about the side-effects of drugs.

Patient may be in denial about treatment.

Question 15

Features of a personal asthma action plan

Answer 15

List:
- Daily medication taken and why.

• The triggers to avoid that bring up symptoms/attacks.
• Indicators, like increase in coughing.
• Names and doses of medication to be taken if asthma worsens.
• Indicators that detail how and when to seek medical attention.

Question 16

General features of acute severe asthma attack

Answer 16

PEF is 33-50% of predicted

Patient cannot complete their sentences

Respiratory rate > 25 breaths/min

Pulse> 110 bpm

Question 17

Life threatening features of acute severe asthma attack

Answer 17

Hypoxia- O2 below 92%

Silent chest

Bradycardia/ hypotension

Exhaustion, confusion

May fall into coma

Question 18

Management of acute severe asthma

Answer 18

O2 at high dose- uncontrolled.

Corticosteroids

Nebulised bronchodilators (in mist form)

IV MgSO4, salbutamol or aminophylline.

When very bad- IPPV

Question 19

Corticosteroid given in acute severe asthma

Answer 19

Prednisolone

40-69 mgs orally

IV hydrocortisone if patient is unable to take prednisolone orally.