Asthma

Question 1

how do we characterize asthma

Answer 1

hyperactive airway
bronchoconstriction
reversibility of airway obstruction

Question 2

how do we diagnose asthma in childhood

Answer 2

chronic persistent cough

responds to bronchodilator

Question 3

how do we diagnose asthma in general

Answer 3

FEV 1 increase of greater than 12% 15-20 mins following inhalation of salbutamol
20% improvement of PEF from baseline

Question 4

symptoms and signs of asthma

Answer 4

coughing
wheezing 
dyspnea 
chest tightness  
precipitated by a range of factors

Question 5

difference between Asthma and COPD

Answer 5

COPD is irreversible 
COPD are smokers 
chronic productive cough 
persistent breathlessness 
not seasonal 
no day to day variability 
unfavorable response to glucocorticoids

Question 6

how to diagnose COPD

Answer 6

smoking history (more than 10 years)
chronic cough
chronic dyspnea

Question 7

how do we assess asthma severity

Answer 7

mild- day symptoms less than twice a week, night symptoms less than once a month and PEF of greater  than 80%
mild 2- 
daytime 3-4 times a week
night 2-4 times a month
PEF more than 80 
moderate-
PEF 60-80%
night symptoms more more than 4 times a month
and day more than 4 times a week
severe-
continuous daytime and frequent night time symptoms 
PEF less than 60

Question 8

relivers

Answer 8

short acting bronchodilators
salbutamol- short acting b2 agonists
use when need in chronic persistent asthma

anticholinergics
ipratropium bromide- less effective than b2
onset of action 30 mins

Question 9

controllers

Answer 9

drugs with anti- inflammatory and sustained bronchodilator action
inhaled cortico
beclomethasone- 200mg 12 hourly
if not controlled double if not, switch  to salmeterol and fluticasone 50/250 1 puff 12 hourly 
oral cortico
prednisone 
b2 agonists 
salmeterol
formoterol

Question 10

how to assess control

Answer 10

if controlled: 
no exacerbations
normal lung function
reliever meds 
no nocturnal symptoms 
no limitation in activity 
less than 2 day time symptoms per week

Question 11

mechanism of action of inhaled corticosteroids

Answer 11

bind to GC receptors- alter gene expression and cause anti- inflammatory action

Question 12

side effects of inhaled cortico

Answer 12

orophary candidiasis

hoarseness

Question 13

long acting B 2 agonists mech of action

Answer 13

bind to b2 receptors- stimulate adenylyl cyclase and increase CAMP leading to bronchodilation
no inflammatory effect
always use with glucocorticoids
side effects tremor/ palpitations

Question 14

theophylline mechanism of action

Answer 14

non selective inhibition of phosphodiesterase resulting in bronchodilation and anti-inflammatory effects(inhibits release of mediators
add on therapy

Question 15

side effects of Theophylline

Answer 15

side effects
nausea, vomiting
arrhythmias
CNS- tremor, confusion, seizures

Question 16

oral corticosteroids function

Answer 16

after acute exacerbation

severe and poorly controlled asthma

Question 17

side effects of corticoids

Answer 17

hypertension
fluid electrolyte disturbance 
anti- inflammatory 
growth retardation
hyperglycemia 
peptic ulcers 
muscle weakness 
cataracts
osteoporosis 
cushings syndrome 
dyslipidemia 
depression
HPS axis adrenal atrophy and inadequate stress response

Question 18

medications that aggravate asthma

Answer 18

NSAIDS, aspirin, beta blockers

Question 19

why would asthma be poorly controlled

Answer 19

poor adherence
poor technique
exposure to triggers
confusion of when to use reliever or inhaler
might not be asthma- heart failure, COPD, GORD, foreign body aspiration in kids
rhinitis or sinusitis

Question 20

acute management of asthma

Answer 20

beta 2 agonist by nebuliser or spacer
corticosteroids oral prednisone or iv hydrocorisone
IP bromide if response to salbu is poor
iv magne sulphate

Question 21

why should we not use intravenous aminophylline

Answer 21

do not use intravenous aminophylline- leads to increased side effects (vomiting and dysrhythmias)

Question 22

classify COPD

Answer 22

mild- FEV more than 80 and predicted symptoms of cough and sputum

Question 23

management of COPD

Answer 23

Salbutamol with spacer
if no response give LABA
if inadequate control add theophylline slow release 200 mg at night
do not give oral corticosteroids for stable COPD

Question 24

what is meant by acute exacerbation of COPD

Answer 24

worsening of dyspnoea
increased cough
increased sputum
(exclude CF,PE and pneumonia)

Question 25

how do we manage exacerbation of COPD

Answer 25

nebulised salbutamol
IP bromide
start prednisone if cant take oral give hydrocortisone
discharge with 40mg of pred for 5 days
amoxicillin 500 mg 8 hrly for 5 days
add clavulanic acid for 5 days if recent amoxicillin exposure