Asthma

Question 1

Asthma Definition

Answer 1

Paroxysmal and reversible obstruction

• Bronchospasm
• Excessive production of secretions

Question 2

Asthma Adult Onset v Child Onset

Answer 2

Adult asthma more often non-atopic and severe, lower remission rate

Question 3

Asthma RFs

Answer 3

FHx, Hx of atopy, prematurity and low birth weight, obesity, smoking

Question 4

Asthma Presentation

Answer 4

• More than one of; wheeze, breathlessness, chest tightness, cough especially if
• Worse at night and early morning, in response to exercise, allergen exposure and cold air, symptoms present after taking aspirin or BBs
• Hx of atopy
• FHx of asthma
• Widespread wheeze on auscultation
• Low FEV1 or PEF
• Unexplained peripheral blood eosinophilia

Question 5

Harrison’s Sulci?

Answer 5

Chest wall deformity from chronic respiratory disease

Question 6

Asthma Differentials

Answer 6

Bronchiolitis, CF, reflux, COPD, CHF, CHD, foreign body, anaphylaxis, pneumothorax

Question 7

Asthma Ix

Answer 7

PEFR, spirometry, CXR

Question 8

Status Asthmaticus Types

Answer 8

• Gradual onset; 80%, slow onset over 48 hours, slow response to treatment
• Sudden onset; older patients, present between midnight and 8am, swifter response

Question 9

Status Asthmaticus Signs

Answer 9

Patient appears pink, RR is raised, tachycardia from beta agonists, accessory muscle, >1:2 ratio, wheeze

• Beware the silent chest
• Patients with severe asthma may not appear distressed
• Any abnormality should alert doctor
• Always assign most severe category when unsure

Question 10

Moderate Asthma Exacerbation

Answer 10

• PEFR >50-75% best or predicted
• Sp02 ≥92
• Speech normal
• RR<25
• HR<110

Question 11

Acute Severe Asthma

Answer 11

• PEFR 33-50% best or predicted
• Sp02 ≥92%
• Can’t complete sentences
• RR≥25
• HR ≥110

Question 12

Life-Threatening Asthma

Answer 12

Any one of the following

• PEFR <33 best or predicted
• 02 sats <92
• Pa02 <8
• PaC02 normal (should be hypocapnic)
• Cyanosis, poor respiratory effort, silent chest
• Arrhythmia or hypotension
• Exhaustion, altered consciousness

Question 13

Status Asthmaticus Management

Answer 13

• Assess severity
• 02 to maintain sats
• Salbutamol 5mg NEB
• If severe/life-threatening add ipratropium 0.5mg/6h to nebs
• Hydrocortisone 100mg IV or prednisolone 40-50mg PO
• Reassess every 15mins
• If PEFR <75% repeat salbutamol nebs and add ipratropium 0.5mg/6hr
• Monitor ECG; watch for arrhythmias
• Consider MgSO4 1.2-2g IV over 20mins if severe/life-threatening and not responding to treatment
• If improvement within 15-30mins; continue nebs for 4-6h, prednisolone 40-50mg PO OD for 5-7 days
• Monitor peak flow