Asthma

Question 1

What is asthma?

Answer 1

chronic inflammatory condition of the airways causing episodic exacerbations of bronchoconstriction

Question 2

bronchoconstriction

Answer 2

smooth muscles of airways contract

narrowing of airways

Question 3

airway obstruction in asthma

Answer 3

reversible

responds to bronchodilators eg salbutamol

Question 4

what is bronchoconstriction caused by?

Answer 4

hypersensitivity of the airways and can be triggered by environmental factors

Question 5

typical triggers

Answer 5

infection 
night time or early morning
exercise 
animals
cold/damp
dust 
strong emotions

Question 6

presentation suggesting diagnosis of asthma

Answer 6

episodic symptoms
diurnal variability - worse at night
dry cough with wheeze and SOB
history of other atopic conditions 
family history 
bilateral wheeze

Question 7

atopic conditions

Answer 7

eczema, hayfever and food allergies

Question 8

presentation indicating diagnosis other than asthma

Answer 8

wheeze related to coughs and colds - VIW
isolated/productive cough
no response to treatment
unilateral wheeze

Question 9

first line investigations

Answer 9

fractional exhaled nitric oxide

spirometry with bronchodilator reversibility

Question 10

further investigations

Answer 10

peak flow variability

direct bronchial challenge test

Question 11

what do you use with direct bronchial challenge test?

Answer 11

histamine or metacholine

Question 12

NICE guidelines asthma

Answer 12

Add SABA inhaler
add low dose ICS
add oral LTRA eg montelukast
Add LABA

Question 13

Additional management of asthma

Answer 13

yearly flu jab
yearly asthma review
avoid smoking

Question 14

Presentation of acute asthma

Answer 14

progressively worse SOB
fast resp rate
symmetrical expiratory wheeze on auscultation
reduced air entry

Question 15

grading acute asthma - moderate

Answer 15

PEFR 50-75% predicted

Question 16

grading acute asthma - severe

Answer 16

PEFR 33-50% predicted
resp rate >25
heart rate >110
unable to complete sentences

Question 17

grading acute asthma - life threatening

Answer 17

PEFR <33%
sats <92%
tired, no wheeze - silent chest
haemodynamic instability

Question 18

treating moderate acute asthma

Answer 18

nebulised beta 2 agonst - salbutamol 5mg
nebulised ipratropium bromide
steroids - oral prednisolone or IV hydrocortisone

Question 19

treating severe acute asthma

Answer 19

oxygen: maintain sats 94-98%
aminophylline infusion
consider IV salbutamol

Question 20

life threatening acute asthma

Answer 20

IV magensium sulphate infusion

intubation if severe

Question 21

ABGs in asthma

Answer 21

initially respiratory alkalosis as tachypnoea leads to CO2 drop
respiratory acidosis due to high CO2 is very bad sign

Question 22

monitoring acute asthma

Answer 22

resp rate, resp effort

peak flow, O2 sats, chest auscultation

Question 23

salbutamol and potassium

Answer 23

monitor serum potassium on salbutamol as can cause potassium to be absorbed from blood into cells and cause a fast heart rate