Asthma

Question 1

What are the symptoms of asthma?

Answer 1

Wheezing
Bretahlessness
Chest tightness
Cough

Question 2

When are asthma symptoms worse?

Answer 2

At night and/or early morning

Question 3

What investigations can be performed when asthma is suspected?

Answer 3

Serial peak expiratory flow measurements
Spirometry
Metacholine or histamine bronchial provocation test
Exhaled nitric oxide
CXR
Skin prick test of specific IgE levels

Question 4

What spirometry results will be seen in asthma?

Answer 4

Since asthma is often spontaneously irreversible there may be normal. results
Airflowobstruction, >400ml improvement in FEV1 following bronchodilator

Question 5

What result would you expect from a metacholine or histamine bronchial provocation test in asthma?

Answer 5

Drop of 20% in FEV1 form baseline

Question 6

Atopic asthma usually starts in childhood. What type of asthma often starts in middle age?

Answer 6

Non-atopic or intrinsic asthma

Question 7

What are the possible triggers of intrinsic asthma?

Answer 7

Respiratory viruses

Air pollutants

Question 8

What pathological features are seen in asthma?

Answer 8

Increased airway inflammatory cells
Plasma exudation
Oedema
Smooth muscle hypertrophy
Mucous plugging
Shedding of epithelium

Question 9

What cells are involved in the inflammatory reaction in asthma?

Answer 9

Eosinophils
Mast cells
TH2 lymphoctes
Dendritic cells

Question 10

What inflammatory mediators are involved in asthma?

Answer 10

Leukotrienes
Acetylcholine
Histamine
Prostaglandin

Question 11

On histology, what changes are seen in the airways in asthma?

Answer 11

Thickening of airway wall
Loss of ciliated columnar cells
Increased number and activity of mucous secreting goblet cells
Sub-basement membrane fibrosis
Marked smooth muscle hypertrophy

Question 12

All patients with asthma should be given a SABA to take as required. T/F?

Answer 12

True

Question 13

If a SABA is not enough to manage a patients asthma, what is the next step in treatment?

Answer 13

Low dose inhaled corticosteroid

Question 14

If a SABA and low dose ICS are ineffective in controlling asthma, what is the next step in treatment?

Answer 14

Add an inhaled LABA

Question 15

What is the immediate treatment of an acute asthma exacerbation?

Answer 15

Oxygen 40-60% to maintain SpO2 at 94-98%
Salbutamol 5mg or terbutaline 10mg via oxygen driven nebuliser
Ipratropium bromide 0.5mg via oxygen driven nebulsier
Prednisolone 40mg of 100mg IV hydrocortisone
No sedatives

Question 16

If there are life threatening features or a patient doesn’t improve after 15-3- minutes how should an acute asthma exacerbation be managed?

Answer 16

1.2-2g of IV magnesium sulphate

IV aminophylline or IV salbutamol

Question 17

How is an acute severe asthma exacerbation defined?

Answer 17

Any one of the following:
PEF 33-50% of best or predicted
RR >25/min
HR >110/min
Inability to complete sentences in one breath

Question 18

How is a life threatening acute asthma exacerbation defined?

Answer 18

Any one of:
PEF <33% of best or predicted
SpO2 <92% 
PaO2 <8kPa
Normal PaCO2
Silent chest
Cyanosis
Poor respiratory effort
Arrhythmia
Exhaustion, altered conscious level