Asthma

Question 1

Asthma is an obstructive airway disease. True or false?

Is it reversible?

Answer 1

True

Reversible airway obstruction

Question 2

What happens to smooth muscle in airway remodelling?

Answer 2

Hypertrophy - (reduces lumen of airway)

Question 3

More mucus is produced by asthmatics. Why is this? What complication can arise from this?

Answer 3

Increase number of goblet cells

Mucus plugs can form -> (lung collapse)

Question 4

What leukocyte is associated with asthma?

Answer 4

Eosinophils

Question 5

Describe the balance between TH1 and TH2 cells in asthma?

Answer 5

Increase in both

Higher ratio of TH2 to TH1

Question 6

What antibody mediates asthma?

Answer 6

IgE

Question 7

What effect does the parasympathetic system have on airways?

Answer 7

Bronchoconstriction

Question 8

What must be noted about sympathetic nervation of the bronchi?

Answer 8

There is no innervation

Relies on adrenaline released from adrenal glands to act on B2 receptors -> vasodilation

Question 9

What is a wheeze?

Answer 9

High pitched expiratory sound

Question 10

Classic presentation of asthma?

Answer 10

CDE
Cough - dry
Dyspnoea/ diurnal variation
Expiratory wheeze

Question 11

What is the difference between atopic/extrinsic and non-atopic/intrinsic asthma?

Answer 11

Atopic/extrinsic = allergic -> e.g. dust mites, animal fur, pollen

Non-atopic/intrisnic = non-allergic -> cold air, polluted air, smoking, exercise

Question 12

Describe spirometry results for asthma

Answer 12

FEV1/FVC <75%
FVC normal
FEV1 reduced

Question 13

Describe peak flow results for asthma

Answer 13

<80% of average

Average of 3 readings

Question 14

How much of a positive result must have a patient have to B agonists?

Answer 14

> 15%

Question 15

How do you treat an asthma attack?

Answer 15

OH SHIT MAN

Oxygen - high flow 100%
Salbutamol - nebuliser
Hydrocortisone IV/ prednisilone oral
Ipratropium nebuliser via oxygen
Theophylline IV
Magnesium sulphate IV and call
Anathesist

Question 16

Pathway of treatment for asthmatics

Answer 16

SABA (PRN)
->
Gluccocortoid Steroids (2x daily)
-> 
LABA
-> 
Increase steroid/ CysLT1 agonist 
-> 
^^/ add LAMA/ methyl-xanthines 
-> 
Anti-IgE injection

Question 17

What can be used to increase drug efficiency?

Answer 17

Spacer

Question 18

Feature of severe acute asthma attack?

Answer 18

Silent chest

Question 19

Name a SABA

Answer 19

Salbutamol

Question 20

What drug would be used in exercise induced asthma in children/ allergic asthma?

Answer 20

Inhaled sodium cromoglycate

Question 21

Name a methyl-xanthine (has many side effects and drug interactions)

Answer 21

Theophylline

Question 22

Name a selective LAMA and non-selective SAMA

What does the selective LAMA block?

Answer 22

Selective LAMA (M3) - Tiotroponine

Non-selective SAMA - ipatropium

Question 23

Name the anti-IgE injection used in symptomatic atopic patients of Max steroid intake

Answer 23

Omalizumab

Prevents IgE binding -> no inhibitor release from basophils and mast cells

Question 24

What are the PEFR of the following categories of asthma:
Acute moderate
Acute severe
Life threatening

Answer 24

Acute moderate - 50-75%
Acute severe - 33-50%
Life-threatening - <33%

Question 25

What gets deposited in basement membrane, submucosa and mucosa in airways which causes airway obstruction in asthma to be irreversible?

Answer 25

Collagen deposits after repair of unresolved airway inflammation

Question 26

How often can you take a SABA?

Answer 26

2 puffs every 5-10mins until relieved