Asthma ☺️

Question 1

Presentation/Symptoms

Answer 1

Chest tightness
Dry cough
SOB
Tripod position
Worse at night/early morning
Worse post exercise, NSAID, Bb use

Question 2

Signs

Answer 2

Expiratory wheeze
Hyperresonance on percussion
Hyperinflated chest
Tachyapnoea
Silent chest

Question 3

Risk factors

Answer 3

Part of atopic triad
-Allergic rhinitis
-Eczema
-Asthma
FHx
Smoking
Frequent chest infections
Exposure to triggers at work

Question 4

Pathophysiology

Answer 4

Reversible obstructive respiratory disorder

• bronchial SM contraction
• mast cell degranulation => inflammation
• mucous hypersecretion

Question 5

Epidemiology

Answer 5

Young people

Females more than males

Question 6

Differentials

-VITAMIN CDEF

Answer 6

Vascular

• heart failure => orthopnea, edema, IHD, fine creps
• PE => acute SOB, pleuritic pain, pleuritic rub, Wells score

Iatrogenic/idiopathic
-GERD => cough, postural/food related, vomiting

Autoimmune
-ILD => dry cough, fine creps, clubbing

Infective/inflammatory

• Bronchiectasis => coarse crepitations, freq chest infections, sputum
• TB => persistent productive cough, haemoptysis

Neoplastic
-lung cancer => persistent cough, haemoptysis, weight loss

Congenital
-Cystic fibrosis => persistent moist cough, GI symptoms, failure to thrive

Endocrine/environmental

• COPD => productive cough, smoking history
• ILD => dry cough, fine creps, clubbing

Functional

• Anxiety, panic attack
• Foreign body aspiration => stridor, reduced chest wall mv

Question 7

Investigations

Diagnostic criteria

Answer 7

DEFINITIVE
Spirometry => obstructive pattern (<0.7), with reversibility after BD (12%+)

FeNO - higher than normal

Other options
Peak flow diary for 2-4wks => reduced lung capacity with variability

Question 8

Treatment plan

Answer 8

1. SABA (salbutamol)
2. SABA + ICS (beclamethasone)
3. SABA + ICS + LTRA (montelukast)
4. SABA + ICS + LABA (salmeterol)

Question 9

SE of SABA, ICS

Answer 9

SABA
-fine tremor

ICS

• oral candida
• stunted growth in children