Asthma

Question 1

What is checked in the annual asthma review? (3)

Answer 1

Difficult sleeping in last month/week

Usual asthma symptoms during the day

interference with ADL

Question 2

A 45 year old man comes in wheezing and short of breath. On examination you can hear breath sounds in his left lung but you cannot hear any breath sounds in his right lung. What is the most likely diagnosis?

Answer 2

Foreign Body aspiration

Question 3

What are the features of acute severe asthma? (4)

Answer 3

Peak flow 33-50% of best or predicted
Respiratory rate >25 per minute
Heart rate >110 bpm
Inability to complete sentences in one breath

Question 4

What should be done before discharging an asthma patient?

Answer 4

Follow up should be within two working days, inhaler technique should be checked, and the patient should be issued with a peak flow meter and a written asthma management plan.

Question 5

Which vaccinations are recommended for asthmatics?

Answer 5

Annual flu vaccine, one off pneumococcal vaccine

Question 6

What is asthma?

Answer 6

A chronic inflammatory disorder of the airways. It is characterised by hypersensitivity, reversible outflow obstruction and bronchospasm.

Question 7

What is an asthma attack?

Answer 7

Acute exacerbations of the condition whereby a trigger (e.g. allergens, exercise) causes sudden inflammation and contraction of the smooth muscle around bronchioles (bronchospasm).

Question 8

What type of hypersensitivity reaction is atopic asthma?

Answer 8

Type I IgE-mediated hypersensitivity reaction

Question 9

What are the typical symptoms of asthma? (5)

Answer 9

wheeze, chest tightness, intermittent breathlessness, cough (often nocturnal) and sputum, diurnal variation

Question 10

What are classic precipitants of asthma?

Answer 10

Exercise, allergen, cold

Question 11

If occupational asthma or home allergen is suspected, how is it investigate?

Answer 11

Peak flow diary at work/home

Question 12

What are the signs of acute asthma attack? (5)

Answer 12

Tachypnoea, widespread polyphonic wheeze, hyperinflated chest, hyper resonant percussion note, decreased air entry.

Question 13

what are the signs of life-threatening asthma? (6)

Answer 13

silent chest, confusion, exhaustion, cyanosis (PaO2<8KPa, PaCO2 4.6-6.0, SpO2 <92%); bradycardia, PEF <33% predicted.

Question 14

How is asthma diagnosed? (4)

Answer 14

Compatible clinical history +

A diurnal variation in PEF of more than 20% (the lowest values typically being recorded in the morning) on 3 days a week for 2 weeks

OR

FEV1 ≥ 15 increase following administration of bronchodilators/trial of corticosteroids

OR

FEV ≥ 15% decrease after 6 mins of exercise

Question 15

What warrants trial of asthma treatment if there is an intermediate probability of asthma?

Answer 15

FEV1/FVC <0.7

Question 16

What tests would you carry out in an acute asthma attack?

Answer 16

FBC, U&Es, blood culture, sputum culture, PEF, ABG, CXR

Question 17

How is asthma managed?

Answer 17

Setting goals, avoid aggravating factors, smoking cessation, inhalers

Question 18

What is the first step of asthma treatment?

Answer 18

inhaled short-acting β2-agonist, such as salbutamol or terbutaline, to be used as required.

Question 19

What is the second step of asthma treatment?

Answer 19

SABA + ICS

Question 20

When should step 2 treatment be initiated?

Answer 20

• exacerbation in last 2 years
• uses SABA ≥3 times a week
• Symptoms ≥3 times a week
• awakened by asthma one night a week

Question 21

What is step 3 treatment

Answer 21

SABA + ICS + LTRA

Question 22

What is step 4 treatment?

Answer 22

SABA + ICS + LABA ± LTRA

Question 23

What is the side effect of inhaled corticosteroids that presents in the mouth?

Answer 23

Oral candida infection

Question 24

what is the target SpO2 on patient on oxygen therapy

Answer 24

94-98%

Question 25

How is a mild exacerbation managed?

Answer 25

Short course of oral corticosteroids

Question 26

How is severe asthma attack managed? (7)

Answer 26

1) PEFR, RR, SaO2, ability to speak, pulse, ABGs
2) O2 (SaO2 94-98%)
3) Nebulised SABA with O2
4) Oral prednisolone/IV hydrocortisone
5) Reassess every 15 mins. If PEF <75%, repeat salbutamol and add ipratropium. Monitor ECG. Monitor K+ levels.
6) IV MgSO4
7) Refer to ICU if not improving

Question 27

What happens on discharge after a severe asthma attack? (3)

Answer 27

Gp surgery informed within 24 hours and seen within 2 days, Asthma clinic within 1 month, Respiratory follow up within 2 months and for at least a year,