ASTHMA

Question 1

Asthma

Answer 1

Reversible airflow limitation due to airway hyperesponsivness and bronchial inflammation.
High serum IgE

Question 2

Asthma epidemiology

Answer 2

Peak onset 3-5
either resolves or worsens at adolescence
2nd peak in middle age due to -workplace sensitisation -drugs
Multifactoral.

Question 3

LMW Asthma triggers (non IgE mediated)

Answer 3

Paints, varnishes, coatings
soldering / welding 
Wood dust
Bleaches and dyes 
Metal complexes

Question 4

HMW Asthma triggers (IgE mediated)

Answer 4

Animal fur and faeces
Antibiotics/ drugs
Latex
Platinum
Proteolytics enzymes

Question 5

Non-immune asthma triggers

Answer 5

Cold
Exercise
Atmospherics pollution / irritants
Diet
Emotion
Drugs - NSAIDS BBlockers

Question 6

Asthma management in community

Answer 6

Start at lowest level and increase until symptoms adequately controlled according to ACQ

1. SABA
2. 1 +Beclametasone (inhaled corticosteroid)
3. 2+Leukotrine receptor antagonist
4. LABA+Steroid
5. Specialist advise Re: High does steroid/ oral steroid/ theophylline/ muscarinic receptor antagonist

ALSO EDUCATION & LIFESTYLE MANAGEMENT:
Vaccines
personalised asthma action plan
smoking cessation and weight loss
annual review

Question 7

Grading Acute Exacerbation of Asthma

Answer 7

Moderate: >50% predicted or usual PF Can still speak normally
Severe: 33-50% normal Peak Flow. RR>25. HR>110. Inability to complete sentence in one breath. Increased respiratory effort
Life-Threatening: <33%predicted or usual peak flow. O2<92% altered conciousness/cyanosis/silent chest

Question 8

Treating Acute asthma attack in A&E

Answer 8

1. ABCDE Assesment
2. Give SABA/LABA
3. Admit if -life threatening
   - Previously had life threatening attack
   - serious attack persists after LABA
   - modert attack worsens despite LABA
4. Follow in patient asthma protocol

Question 9

Treating Asthma as anmission

Answer 9

1. Salbutamol Nebs (5mg) up to every 15 minutes
2. High flow o2
3. Prednisalone 50mg PO/ hydrocortisone 100mg IV
4. Ipratroprium 0.5 add in to nebs
5. Magnesium Sulphate 2g IV over 20 mins
   Reassess
   a) ITU call crash team, aneasthatist takes lead Re: Intubation, theophylline, IV salbuytamol
   b) ward based care. 4hrly Nebs. PO Pred for 1 week. Aim Sats >94% Discharge once stable on maintainance medication for 24 hrs. make appointment with GP 1/52 and clinic 1/12