Asthma

Question 1

Presentation of acute asthma attack

Answer 1

Acute SOB

Wheeze

Question 2

Asthma attack triggers

Answer 2

Infection

Travel

Exercise

Cold weather

Dust

Question 3

Ix for acute asthma

Answer 3

PEF

ABG

Bloods

Question 4

ABG findings in acute asthma

Answer 4

PaO2 normal or reduced

PaCO2 decreased, may later rise as pt tires (send to ITU for ?intubation)

Question 5

Severity of acute asthma

Answer 5

Moderate

Severe

Life threatening

Question 6

Moderate acute asthma

Answer 6

PEF > 50% predicted/best

Question 7

Severe acute asthma

Answer 7

Can’t complete sentences with 1 breath

PEF < 50%

RR > 25

HR > 110

Question 8

Life threatening acute asthma

Answer 8

PEF < 33

%SpO2 < 92%

“CHEST”

Cyanosis

Hypotension

Exhaustion, confusion

Silent chest

Tachy-/brady-/arrhythmias

Question 9

Admission criteria for asthma

Answer 9

Life threatening acute asthma

Severe acute asthma persisting despite initial Rx

Question 10

Discharge criteria for acute asthma

Answer 10

Stable on discharge meds > 24 hrs

PEF > 75% 1hr after initial Rx

Question 11

Mx of acute asthma

Answer 11

Sit up/O2

Nebulised Salbutamol 5 mg every 15 mins

Prednisolone 40 mg / IV hydrocortisone 100 mg

Ipratropium 0.5 mg every 4 hrs

Consider aminophyline

If life threatening - MgSO4 2g IV over 20 mins

Question 12

Age of chronic asthma

Answer 12

Peaks at 5yrs, most outgrow by adolescence

Question 13

Pathophysiology of acute asthma

Answer 13

• Mast cell-Ag interaction → histamine release
• Bronchoconstriction, mucus plugs, mucosal swelling

Question 14

Pathophysiology of chronic asthma

Answer 14

• TH2 cells release IL-3,4,5 → mast cell, eosinophil and B cell recruitment
• Airway remodelling

Question 15

General causes of asthma

Answer 15

Atopy

Stress

Drugs: NSAIDS, β-Blockers

Question 16

symptoms of chronic asthma

Answer 16

• Cough ± sputum (often at night)
• Wheeze
• Dyspnoea
• Diurnal variation with morning dipping

Question 17

Things to consider when taking an asthma history

Answer 17

• Precipitants
• Diurnal variation
• Exercise tolerance
• Life effects: sleep, work
• Other atopy: hay fever, eczema
• Home and job environment

Question 18

signs of asthma

Answer 18

• Tachypnoea, tachycardia
• Widespread polyphonic wheeze
• Hyperinflated chest
• ↓ air entry

Question 19

Diseases associated with asthma

Answer 19

• GORD
• Churg-Strauss
• Allergic Bronchopulmonary Aspergillosis (ABPA)

Question 20

Blood results for asthma

Answer 20

FBC (eosinophila)

↑IgE

Aspergillus serology

Question 21

Spirometry results for asthma

Answer 21

Obstructive pattern

FEV1:FVC < 0.75

≥15% improvement in FEV1 with β-agonist

Question 22

PEFR results for asthma

Answer 22

Diurnal variation >20%

Morning dipping

Question 23

Conservative management of asthma

Answer 23

TAME

Technique for inhaler use

Avoidance: allergens, smoke (ing), dust

Monitor: Peak flow diary (2-4x/d)

Educate (Rx compliance, Emergency action plan)

Question 24

Chronic asthma meds (British Thoracic Society Guidelines)

Answer 24

1. SABA + ICS
2. LABA
3. increase ICS
4. Leukotriene receptor antagonist/Theophylline
5. Prednisolone

Question 25

SABA eg

Answer 25

Salbutamol

Question 26

LABA eg

Answer 26

Salmeterol

Question 27

ICS eg

Answer 27

Beclomethasone

Question 28

Leukotriene receptor antagonist eg

Answer 28

Montelukast