Asthma

Question 1

Definition

Answer 1

Constriction of trachea and bronchi

Question 2

Features

Answer 2

Airway trapped in alveoli
Tight smooth muscle around airways
Narrow, tight and inflammed airways

Question 3

Pathophysiology

Answer 3

1. Airway inflammation mediated by immune system leads to
   - narrowing of airways
   - increased reactivity of airway ( narrowing)

Question 4

Aetiology

Answer 4

Hereditary - atopy (body's predisposition to develop antibody IgE in response to environmental allergens; associated with hay fever, eczema, allergic rhinitis, asthma
Gene ADAM33. ORMDL3
Occupation - asbestos
Smoking
Diet
Hygiene

Question 5

Symptoms

Answer 5

Usually worse in the morning & night 
Wheeze on expiration
Chest tightness
Cough
Shortness of breath

Question 6

Investigations - evidence of:

Answer 6

Evidence of wheeze, variability and response to treatment

Question 7

Investigations - variability

Answer 7

Daily (nocturnal / early morning)
Weekly (occupation, better when off work, holiday)
Annual (environmental allergens)

Question 8

Investigations - important aspects in history

Answer 8

PMH: eczema, wheeze in infancy, bronchitis, childhood asthma, hay fever
DH: inhalers, B-blockers, aspirin, NSAIDS
FH: asthma, atopic disease
SH: tobacco, drugs, pets occupation

Question 9

Investigations - tests

Answer 9

Spirometry - respiratory function of lungs by the volume of air expired over time (normal is FEV1/FVC = 80%, in obstructive disease it is less than 70%) - treat with B2 agonist or oral steroid
Peak flow monitoring - should be fluctual due to changes at night/morning. Variability shown greater than 20% on at least 3 consecutive days
Exhaled nitric oxide (FeNO) - shows airway inflammation - higher than 35 ppb
Airway responsiveness - histamine, mannitol
CXR - hyper inflated chest
FBC - Eosinophilia
Skin prick test - atopic status
Total and specific IgE - atopic status

Question 10

Asthma in Children

Answer 10

Under 18m, most likely infection

Over 5yo, most likely asthma

Question 11

Triggers

Answer 11

Cold air, exercise, pets, pollen, drugs(aspirin and NSAIDS), cigarette smoke, food, strong scents, URTIs

Question 12

Aims for treatment

Answer 12

No need for rescue medication
No asthma attacks 
No limitation to exercise 
No daytime symptoms
No wakening at night due to asthma

Question 13

Treatment - ADULTS

Answer 13

1. Low dose Inhaled corticosteroids (ICS)- bronchodilators
2. Add LABA to ICS
3. No response to LABA - remove and increase ICS dose
4. Add LTRA, LAMA
5. Steroid tablet

Question 14

Treatment - inhaler types

Answer 14

MDI - metered dose inhaler
DPI - dry powder inhaler
Short acting Beta2 agonist - Salbutamol, terbutaline

Question 15

Treatment - oral

Answer 15

Leukotriene Receptor Antagonist
Theophylline
Prednisolone

Question 16

Treatment - CHILDREN

Measure control:

Answer 16

Short acting beta agonist/week
Absence school/nursery
Nocturnal symptoms/week
Excertional symptoms/week

Question 17

Treatment

Answer 17

1. Very Low dose inhaled corticosteroids or LTRA if <5yo
2. Add on ILABA if >5yo or LTRA if <5yo
3. Theophylline as an Add on
   LABA only used with ICS

Chronic treatment - Inhaled corticosteroids
Acute treatment - Oral steroids