Asthma

Question 1

What is asthma?

Answer 1

Asthma is a reversible chronic airways disease characterised by paroxysmal obstruction.

Question 2

What are the main types of asthma?

Answer 2

Eosinophilic - extrinsic/ atopic or intrinsic/non-atopic

non-eosinophilic.

Question 3

What is the pathophysiology of eosinophilic asthma?

Answer 3

Inflammation with bronchial hyper-responsiveness, causing bronchoconstriction, inflammation of the mucosa, and increased mucus secretion. [medsoc]
Inflammation causes plasma exudation, oedema, smooth muscle hypertrophy, matrix deposition, mucus plugging and epithelial damage.

Question 4

Give 5 signs of an asthma attack.

Answer 4

Audible wheeze
Low oxygen saturations
Tripoding (hand on knees like a breathless runner)
Use of accessory muscles
Tachypnoea
Cyanosis

Question 5

Give 3 symptoms of asthma.

Answer 5

Wheeze, dyspnoea, dry cough, worse in the morning (diurnal variation).

Question 6

Give 3 risk factors for atopic asthma.

Answer 6

Genetic predisposition, environmental stimuli, hygiene hypothesis (lack of exposure to pathogens–> weak immune system)

Question 7

Give 3 risk factors for non-atopic asthma.

Answer 7

Stress, cold air, infection.

Question 8

Give 3 factors that can exacerbate asthma.

Answer 8

Cold air, infection, allergens, exercise.

Question 9

What defines a severe asthma attack?

Answer 9

any one of:
Peak flow 33-50% predicted
Resp rate 25+
HR 110+
Inability to complete sentences
(Worse than moderate, better than life-threatening)

Question 10

Apart from oxygen, give 2 drugs and their drug class you could give in the management of asthma.

Answer 10

Short-acting beta-2 agonist eg salbutamol
Long-acting beta-2 agonist eg salmeterol
Corticosteroid eg hydrocortisone, prednisolone; inhaled beclomethasone.
[medsoc]

Question 11

Describe the immediate management of an asthma attack.

Answer 11

OSHITME
Oxygen 40-60%
Salbutamol neb 5mg
Hydrocortisone IV/ prednisolone oral 30-60mg
Ipratropium bromide (antimuscarinic) if life-threatening
Theophylline/ aminophylline
Magnesium
Escalate care before aminophylline

Question 12

What would a normal PaCO2 with altered conscious level and cyanosis indicate?

Answer 12

Life-threatening severe asthma. NORMAL PACO2 IS BAD!

Question 13

Give 3 differential diagnoses for a cough other than asthma. [GP objective]

Answer 13

Sarcoidosis, malignancy, GORD, bronchiectasis
Upper airway cough syndrome (postnasal drip: excessive mucus is produced by nasal mucosa which accumulates in throat or back of nose).
[pts]

Question 14

Give 3 differential diagnoses for a SOB other than asthma. [GP objective]

Answer 14

COPD
Congestive heart failure
Pneumonia
Malignancy
Sarcoidosis

Question 15

Describe the management of asthma.

Answer 15

SABA (salbutamol)
\+ ICS (beclomethasone)
\+ LABA (salmeterol)
\+ Leukotriene antagonist/aminophylline
\+ oral prednisolone

Question 16

How do leukotriene antagonists work?

Answer 16

Leukotrienes cause bronchial smooth muscle contraction. The antagonists inhibit production or activity of leukotrienes, causing bronchial dilation. [wiki]