Asthma

Question 1

What is asthma?

Answer 1

A chronic inflammatory disease of the airways

Question 2

What is the airway obstruction like in asthma?

Answer 2

Reversible

Question 3

What can happen to airway responsiveness in response to stimuli?

Answer 3

Increased responsiveness that leads to airway narrowing

Question 4

What are the most likely differentials for a wheeze?

Answer 4

Acute asthma exacerbation

Bronchitis (viral or bacterial)

Question 5

What are some other, less likely, differentials for wheeze?

Answer 5

Pulmonary oedema, PE, vocal cord dysfunction, GORD, foreign body, allergy, hyperventilation/psychosocial, cardiac disease, vasculitides
Carcinoid syndrome with hepatic mets - release HIAA

Question 6

Describe asthma pathophysiology

Answer 6

Airway epithelial damage (shedding and sub epithelial fibrosis, BM thickening)
Inflammatory reaction amplified by cytokines
Increased numbers of goblet cells (more mucus) and hyperplasia and hypertrophy of SM
Mucus plugging (severe)

Question 7

What cells is an asthmatic inflammatory reaction characterised by?

Answer 7

Eosinophils, Th2, Mast cells

Question 8

Name some inflammatory mediators in asthma?

Answer 8

Histamine, leukotrienes, prostaglandins

Question 9

How do you measure asthma exacerbation severity?

Answer 9

Mild PEFR <75%
Moderate PEFR 50-75%
Severe PEFR 33-50%, can’t complete sentences, RR >25, HR >110
Life threatening PEFR <33%, sats <92%, cyanosed, confused etc
Severe Raised pCO2

Question 10

What is the management for acute asthma?

Answer 10

ABCDE
Sats 94-98%
5mg neb salbutamol (repeat every 15 min)
40mg oral prednisolone

Question 11

What drug should be considered in severe asthma?

Answer 11

neb ipratroprium bromide 500mg

back to back salbutamol

Question 12

What drug could be considered in life threatening asthma?

Answer 12

IV aminophylline

Question 13

What are the criteria for safe discharge following acute asthma exacerbation?

Answer 13

PEFR >75%
Stopped regular news 24hrs prior to discharge
Inpatient asthma nurse review to assess inhaler technique
Provide PEFR meter and written asthma action plan
5 Days oral prednisolone
GP follow up in 2 days
Rest clinic follow up in 4 weeks

Question 14

How can asthma patients with eosinophilic inflammation be treated?

Answer 14

Steroids

Question 15

Name some differentials for eosinophilia

Answer 15

Airway inflammation (COPD or asthma), hayfever/allergies, allergic bronchopulmonary aspergillosis, drugs, vasculitis/churg-strauss, eosinophilic pneumonia, parasites, SLE, lymphoma, hypereosinophilic syndrome

Question 16

Name some asthma trigger factors

Answer 16

Smoking, URTI, allergens, exercise, cold air, occupation, pollution, drugs like aspirin or beta blockers, stress, psychosocial

Question 17

What should be done in chronic asthma?

Answer 17

Use BTS stepwise management guidelines
Assess inhaler technique
Use self management plans
Avoid triggers