Asthma

Question 1

What percentage of children have asthma

Answer 1

5-10%

Question 2

What percentage of adults have asthma

Answer 2

2-5%

Question 3

What is asthma

Answer 3

Reversible airflow obstruction due to bronchial hyper reactivity

Question 4

Describe the cellular response to asthma

Answer 4

Allergen triggers IgE production which triggers a B cell - T cell interaction causing degranulation of mast cells which eventually leads to narrowing of the airway, oedema and mucous secretion

Question 5

What can cause narrowing of the airways

Answer 5

Bronchial smooth muscle contraction
Bronchial mucosal oedema
Excessive mucous secretion into the airway lumen

Question 6

Describe the names of biologic drugs

Answer 6

Usually end in -mab or -ib

Question 7

What are the symptoms of asthma

Answer 7

Cough
Wheeze
Shortness of breath
Diurnal variation - worse overnight and early morning
Difficulty breathing out and lungs fill with air

Question 8

What causes an asthma cough

Answer 8

The high levels of mucous being produced in the airway causing irritation

Question 9

What is used to track airway resistance and how should it be checked

Answer 9

PEFR - peak expiratory flow rate

Only check morning against morning and evening against evening

Question 10

What are common triggers of asthma

Answer 10

Unknown
Infections
Environmental stimuli - dust, smoke, chemicals
Cold air - chilling of the airways
Atopy

Question 11

What can be carried out to help treat asthma caused by atopy

Answer 11

A skin prick test

Question 12

Describe the asthma biphasic response

Answer 12

After a patient recovers from an acute asthma attack they are not back to normal
Hours later they may develop a more significant response

Question 13

How should an asthma biphasic response be treated

Answer 13

In acute attack, B agonists are important to try and open the airways quickly but a corticosteroid must also be given to prevent the later response

Question 14

Give examples of common asthma drugs

Answer 14

Intermittent short acting beta-adrenergic agonists
Inhaled corticosteroids - low dose
Inhaled corticosteroids - high dose
Regular long acting B agonists
Adjuvant therapy

Question 15

Give examples of adjuvant therapy for treating asthma

Answer 15

Regular montelucast - a leukotriene inhibitor
Pulsed oral steroid - prednisolone
Biologic therapy

Question 16

How should B agonists be taken to be most effective

Answer 16

Nebulised just as effective as IV

Question 17

What is the most effective asthma treatment

Answer 17

Corticosteroids

Question 18

How should corticosteroids be used alongside B agonists

Answer 18

If short acting B agonist >3 times each week then use low dose corticosteroid every day
Move to high dose corticosteroid if symptoms dictate

Question 19

What should the daily dose of corticosteroids be under

Answer 19

<1500ug in adults

<800ug in children

Question 20

Which patients are at the top of the asthma risk assessment pyramid

Answer 20

Those who have been permitted to hospital with asthma or those who have had to use an oral steroid in the past year

Question 21

Which patients are at the bottom of the asthma risk assessment pyramid

Answer 21

Those with a blue or brown inhaler

Question 22

What does an asthma self assessment look for

Answer 22

Changes which suggests the asthma is getting more severe and what actions they need to take with certain levels of breathing and speaking so an ambulance is called appropriately and the patient doesn’t leave it too late

Question 23

What aspects of asthma should a dentist know in relation to their patient

Answer 23

Know that the patient has asthma - history
Know the severity of the patients asthma - risk assess
Know the triggers for the patients asthma - avoid these
Know how to assess and treat a patient during an acute asthma attack