Asthma

Question 1

what is the definition of chronic asthma?

Answer 1

Episodic, reversible airway obstruction due to bronchial hyper-reactivity to a variety of stimuli.

Question 2

what is the acute pathophysiology of asthma within the 1st 30mins ?

Answer 2

Mast cell-Ag interaction → histamine release

Bronchoconstriction, mucus plugs, mucosal swelling

Question 3

what is the pathophysiology of chronic asthma within the 1st 12hrs ?

Answer 3

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

Airway remodelling

Question 4

what are the symptoms of asthma?

Answer 4

􏰀 Cough ± sputum (often at night)
􏰀 Wheeze
􏰀 Dyspnoea
􏰀 Diurnal variation ̄c morning dipping

Question 5

what key 6 questions should be asked during an asthma history?

Answer 5

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

Question 6

what medications can cause asthma?

Answer 6

Drugs: NSAIDS, β-B

Question 7

how is the wheeze described for asthma?

Answer 7

Widespread polyphonic wheeze

Question 8

what conditions are associated with asthma?

Answer 8

ABPA
Churg-Strauss
GORD

Question 9

what are two DD for asthma?

Answer 9

COPD

pulmonary oedema

Question 10

what blood tests can be done for asthma?

Answer 10

FBC (eosinophila)
raised IgE
aspergillus serology

Question 11

what would CXR show for asthma?

Answer 11

hyperinflation

Question 12

what spirometry pattern show and FEV1:FVC show for asthma?

Answer 12

Obstructive pattern ̄c FEV1:FVC < 0.75

Question 13

by what % does B agonist improve FEV1?

Answer 13

> 15%

Question 14

what general measures can be used for asthma TAME?

Answer 14

technique of inhaler use
avoidance of allergens, smoke, dust
monitor peak flow diary
educate with specialist nurse

Question 15

what is the first step of the asthma ladder?

Answer 15

SABA as acquired

short acting b agonist

Question 16

when does a pt move onto step 2 of the asthma ladder?

Answer 16

use more than once a day

nocturnal symptoms

Question 17

what medication is used for step 2 asthma management ?

Answer 17

Low-dose inhaled steroid: beclometasone 100-400ug bd

Question 18

what medication is used for step 3 asthma management ?

Answer 18

LABA: salmeterol 50ug bd

Question 19

during step 3, what should be done if there is no benefit form the LABA?

Answer 19

↑ steroid to 400ug bd

Question 20

what medication is used for step 4 asthma management ?

Answer 20

Trials of

􏰀 ↑ inhaled steroid to up to 1000ug bd
􏰀 Leukotriene receptor antagonist
􏰀 SR Theophylline
􏰀 MR β agonist PO

Question 21

what medication is used for step 5 asthma management ?

Answer 21

Oral steroids: e.g. prednisolone 5-10mg od

Question 22

what 4 questions should be asked for acute asthma?

Answer 22

􏰀 Precipitant: infection, travel, exercise?
􏰀 Usual and recent Rx?
􏰀 Previous attacks and severity: ICU?
􏰀 Best PEFR?

Question 23

what would an ABG for acute asthma show?

Answer 23

ABG
􏰁 PaO2 usually normal or slightly ↓
􏰁 PaCO2 ↓

Question 24

would should be done if PaCO2 ↑ on ABG during acute asthma ?

Answer 24

send to ITU for ventilation

Question 25

what blood tests can be done for acute asthma?

Answer 25

FBC, U+E, CRP , blood cultures

Question 26

what four features indicate severe acute asthma?

Answer 26

PEFR <50% 􏰀 RR>25 􏰀 HR >110 􏰀 Can’t complete sentence in one breath

Question 27

what 6 features indicate life threatening acute asthma?

Answer 27

PEFR <33% 􏰀 SpO2 <92%, PCO2 >4.6kPa, PaO2 <8kPa 􏰀 Cyanosis 􏰀 Hypotension 􏰀 Exhaustion, confusion 􏰀 Silent chest, poor respiratory effort 􏰀 Tachy-/brady-/arrhythmias

Question 28

what are DD for acute asthma?

Answer 28

􏰀 Pneumothorax 􏰀 Acute exacerbation of COPD 􏰀 Pulmonary oedema

Question 29

what are two indications for admission of acute asthma?

Answer 29

Life-threatening attack Feature of severe attack persisting despite initial Rx

Question 30

when should someone with acute asthma be discharged ?

Answer 30

􏰀 Been stable on discharge meds for 24h 􏰀 PEFR > 75% ̄c diurnal variability < 20%

Question 31

what is the follow up when someone is discharged with acute asthma?

Answer 31

􏰀 PO steroids for 5d 􏰀 GP appointment w/i 1 wk. 􏰀 Resp clinic appointment w/i 1mo

Question 32

what is the initial management of acute asthma?

Answer 32

sit up 100% O2 via non rebreathe mark (aim 94-98%) nebulised salbutamol (5mg) and ipratropium (0.5mg) hydrocortisone 100mg IV or prednisolone 50mg oral write no sedation on drug chart

Question 33

what is the management of life threatening acute asthma?

Answer 33

inform ITU magnesium sulphate 2g IVI over 20mins nebulised salbutomol every 15mins monitor ECG

Question 34

if a patient with acute asthma is improving, how often should nebulised salbutamol be given?

Answer 34

every 4hrs

Question 35

what is the management if someone with acute asthma isn't improving ?

Answer 35

􏰀 Nebulised salbutamol every 15min (monitor ECG) 􏰀 Continue ipratropium 0.5mg 4-6hrly 􏰀 MgSO4 2g IVI over 20min 􏰀 Salbutamol IVI 3-20ug/min 􏰀 Consider aminophylline - Load: 5mg/kg IVI over 20min (Unless already on theophylline) - Continue: 0.5mg/kg/hr - Monitor levels 􏰀 ITU transfer for invasive ventilation