Asthma and smoking cessation

Question 1

Asthma presentation

Answer 1

Wheezing at time
Worse with exercise and cold weather
Dry cough - often nocturnal
Intermittent SOB with exertion - exercise intolerance
Chest feels tight
No chest pain
Relieved with rest
Typical triggers - pets, cold, smoking, stress

Question 2

RF for asthma

Answer 2

Atopy - allergic sensitisation
Exposure to allergens
Smoking
Exposure to animals
Stress
Medication
Diet / nutrition
Recurrent respiratory infections

Question 3

Ix for asthma

Answer 3

Spirometry - FEV1/FEV ratio <70% - bronchodilatory reversibility - increases FEV1 by over 12%

Peak expiratory readings (peak flow)

Fractional exhaled nitric oxide testing (FeNO)

Can’t test under 5yrs old - use clinical judgement

Question 4

Clinical signs of asthmas

Answer 4

Use of accessory muscles
Widespread polyphonic wheeze - on auscultation
Hyper inflated chest
Hyper resonant percussion
Diminished air entry

Question 5

Management of asthma

Answer 5

Lifestyle - weight management, smoking

SABA only if infrequent episodes
If more than 3 episodes a week add low dose ICS ( regular preventer)
If needed add LABA or MART - if no response, stop this
If needed increase ICS to medium dose
If needed specialist care referral

Question 6

What is a MART

Answer 6

Reliever and preventer in one

Question 7

What is a LABA

Answer 7

Preventer inhaler
Inhaled long acting beta 2 agonist
e.g. symbicort/fostair

DRY POWDER INHLAER so SPACER NOT USED

Question 8

What is the reliever inhaler

Answer 8

SABA - short acting beta 2 agonist
e.g. salamol, salbutamol, aeromir
Pressurised inhaler so MUST BE HIVE WITH SPACER TO GET STEROID INTO LUNGS OR MAY CAUSE ORAL THRUSH

Question 9

What is a ICS

Answer 9

Preventer inhlarer
Inhaled corticosteroid e.g. clenil
Pressurised inhaler so NEEDS SPACER

Question 10

MOA of SABA and LABA

Answer 10

Relaxation of bronchial smooth muscle and inhibition of release of mediators of immediate hypersensitivity from mast cells

Question 11

MOA of ICS

Answer 11

Potent anti inflammatory action by reversing capillary permeability and lysosomal stabilisation

Question 12

What is an LTRA

Answer 12

Leukatrine receptor antagonist e.g. montelukast

Question 13

How is LTRA taken?

Answer 13

Once daily oral tablet/chewable

Question 14

MOA of LTRA

Answer 14

Cysteinyl leukotriene (CysLT) receptors are found in human airway and pro inflammatory cells - can cause bronchoconstriction, mucous secretion and permeability and eosinophil recruitment so antagonists inhibit this.

Question 15

Acute asthma presentation

Answer 15

Too breathless to complete sentences
Tachypnoea
Tachycardia
Silent chest
Cyanosis
Hypoxaemia
Wheeze
Reduced breath sounds
Collapse / reduced consciousness
Increased resp effort - accessory muscle use

Recent triggers, inhaler compliance, recent illness or exacerbations, exercise, night time or early morning, increased reliever inhaler use

Question 16

Treatment for acute asthma

Answer 16

Give oxygen if they have hypoxia to achieve 94-98%
SABA
BURST THERAPY - 4 puffs initially, then 2 puffs every 2 minutes until 10 puffs, repeat every 10-20 mins
Double ICS dose and increase SABA usage
Oral prednisolone for 5 days or until symptom improvement
Follow up after 48 hrs and check inhaler technique

Question 17

Signs and symptoms of viral induced wheeze

Answer 17

Upper respiratory viral symptoms
Polyphonic wheeze on auscultation
Increased resp effort
Tracheal tug
Nasal flaring
Intercostal recession
Tripoding

Question 18

Viral induced wheeze management

Answer 18

BURST therapy SABA
Oxygen therapy
Antibiotics if required
Follow up after 48 hrs

Question 19

Options for smoking cessation

Answer 19

Nicotine replacement therapies
- nicotine patch
- lozenges
- chewing gum

Varenicline (champix) - block nicotine receptors in brain - 12 week course - not given in pregnancy, breast feeding or if younger than 18 yrs

Bupropion

Vaping

Community support / counselling