Asthma

Question 1

Asthma?

Answer 1

Chronic inflammatory airway disease characterised by variable reversible airway obstruction, airway hyper-responsiveness and bronchial inflammation.

Question 2

Asthma pathology?

Answer 2

Question 3

Asthma risk factors (9)?

Answer 3

family history, atopy, house dust mites, pollen, pets, cigarettes, viral resp tract infections, occupational allergens.

Question 4

Asthma epidemiology?

Answer 4

10% of hildren, 5% of adults

Question 5

Asthma precipitating factors (5)?

Answer 5

Cold,

viral infection,

drugs (e.g. beta-blockers, NSAIDs),

exercise,

emotions

Question 6

Asthma symptoms?

Answer 6

episodic history, wheeze, breathlessness, cough

Question 7

Asthma signs (5)?

Answer 7

tachypnoea, use of accessory muscles, prolonged expiratory phase, polyphonic wheeze, hyperinflated chest.

Question 8

Asthma signs of a severe attack (4)?

Answer 8

PEFR < 50%

predicted Pulse > 110/min

RR > 25/min

Inability to complete sentences

Question 9

Asthma signs of a life threatening attack (7)?

Answer 9

PEFR < 33% predicted

silent chest

cyanosis

bradycardia

hypotension

confusion

coma

Question 10

Asthma investigations?

Answer 10

Peak flow, pulse oximetry, ABG, CXR, FBC, CRP, U&Es, Blood and sputum cultures.

Question 11

Asthma management acute?

Answer 11

ABCDE, resusitate,

high-flow O2, salbutamol nebulizer, ipratropium bromide, steroid therapy (hydrocortisone followed by prednisalone)

Question 12

Asthma management chronic step 1?

Answer 12

Inhaled short-acting beta-2 agonist used as needed

If needed > 1/day then move onto step 2

Question 13

Asthma management chronic step 2?

Answer 13

Step 1 + regular inhaled low-dose steroids (400 mcg/day)

Question 14

Asthma management chronic step 3?

Answer 14

Step 2 + inhaled long-acting beta-2 agonist (LABA)
If inadequate control with LABA, increase steroid dose (800 mcg/day)
If no response to LABA, stop LABA and increase steroid dose (800 mcg/day)

Question 15

Asthma management chronic step 4?

Answer 15

Increase inhaled steroid dose (2000 mcg/day)
Add 4th drug (e.g. leukotriene antagonist, slow-release theophylline or beta-2

agonist tablet)

Question 16

Asthma management chronic step 5?

Answer 16

Add regular oral steroids Maintain high-dose oral steroids Refer to specialist care

Question 17

Asthma complications (6)?

Answer 17

Growth retardation, chest wall deformity, recurrant infections, pneumothorax, respiratory failure, death.