Asthma and COPD

Question 1

Asthma triggers?

Answer 1

infections, allergens, occupational exposures, food additives and chemicals, irritants, aspirin and strong emotions

Question 2

What lymphocyte is the inflammatory reaction in asthma led by?

Answer 2

Th2 lymphocytic response

Question 3

Investigations for Asthma

Answer 3

• Spirometry and reversibility
• NO test -> rarely used
• Blood test -> eosinophil
• Histamine challenge
• Skin prick/IgE CXR -> mostly to exclude and is usually clear.

Question 4

Criteria to determine if a person has a high probability of asthma

Answer 4

1. recurrent episodes
2. symptom variability
3. absence of symptoms of alternative diagnosis
4. observed wheeze
5. atopy
6. PEF/FEV1

Question 5

How to diagnose Asthma using peak flow?

Answer 5

record peak flow qds for 2-4 wks

Question 6

Mild PEF reading?

Answer 6

>80% of best/predicted

Question 7

Moderate PEF reading?

Answer 7

50-80% of best/predicted

Question 8

Acute Severe PEF reading?

Answer 8

33-50% best/predicted

Question 9

Life threatening PEF reading?

Answer 9

<33% best/predicted

Question 10

What would be considered as a positive result for asthma when doing a bronchodilator reversibility test?

Answer 10

an increase in FEV1 of 12% (or more) and an increase in volume of 200 ml (or more)

Question 11

example of inhaled steroid?

Answer 11

beclamethasone

Question 12

example of oral steroid?

Answer 12

prednisolone

Question 13

example of muscarinic antagonist?

Answer 13

ipatropium

Question 14

example of leukotriene receptor antagonist and what type of asthma is it used to treat?

Answer 14

montelukast and allergy induced asthma

Question 15

Is magnesium used more for asthma or COPD?

Answer 15

COPD

Question 16

Criteria for well controlled asthma?

Answer 16

don’t experience: daytime symptoms night time waking need for rescue meds asthma attacks limited activity abnormal lung fn minimal side effects

Question 17

Treatment pathway for asthma

Answer 17

1. SABA 2. ICS 3. LABA 4. stop LABA and increase ICS 5. consider increasing ICS + alternative treatment + specialist care 6. Oral steroid

Question 18

Management of acute asthma attack?

Answer 18

Oxygen 5mg salbutamol in nebuliser or 50 spacer puffs Prednisolone 40-50mg for 5 days Admit severe asthma

Question 19

When should respiratory specialist follow up patients who’ve had a severe asthma attack?

Answer 19

at least 12 months after admission

Question 20

When should primary care be informed of asthma attack?

Answer 20

within 24 hours of the attack

Question 21

Features of a moderate asthma attack

Answer 21

increasing symptoms PEF >50-75% no signs of severe asthma

Question 22

Features of a severe asthma attack

Answer 22

any one of: PEF 33-50% RR >25 HR >110 can’t complete sentence in one breath

Question 23

Features of a life threatening asthma attack

Answer 23

features of severe asthma plus any one of the following: PEF <33% SpO2 <92% silent chest cyanosis poor respiratory effort arrhythmia exhaustion low GCS hypotension

Question 24

Features of near fatal asthma attack

Answer 24

raised PaCO2 and or requiring mechanical ventilation

Question 25

Things you want to rule out when suspecting COPD

Answer 25

Lung cancer, PE and asthma

Question 26

Investigations for COPD

Answer 26

• FBC (eosinophilia and anaemia)
• CXR (hyperinflation, bullae and flattened diaphragms)
• spirometry with reversibility
• BMI
• ABGs

Question 27

What is the only intervention proven to have a prognostic effect on COPD?

Answer 27

STOP SMOKING

Question 28

Treatment of patient with stable COPD

Answer 28

stop smoking, vaccines, exercise

Question 29

Management of COPD Exacerbations

Answer 29

Increase frequency of SABA

Antibiotics (Amoxicillin 500mg tds)

Offer prednisolone 30mg

(some patients given rescue packs)

Question 30

Stage 1 (Mild) COPD FEV1

Answer 30

>80%

Question 31

Stage 2 COPD (Moderate) FEV1

Answer 31

50-79%

Question 32

Stage 3 (Severe) COPD FEV1

Answer 32

30-49%

Question 33

Stage 4 (very severe) COPD FEV1

Answer 33

<30%

Question 34

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