asthma clinical features

Question 1

what are the key features of asthma

Answer 1

wheeze
variability
responds to treatment

Question 2

what are the inconsistencies of asthma

Answer 2

transient vs persistant 
different severities
diff age at onset 
heterogeneity in response 
diff triggers

Question 3

what causes asthma

Answer 3

gènes 
30-80% of causation 
10 variants making modest contribution
ADAM33, ORMDL3
interact w environment 
epugenetics

Question 4

when is it likely to be asthma in children

Answer 4

examination unhelpful as they are unlikely to be wheezing 
no diagnostic asthma test in children 
- peak flow 
- spirometry lacks specified 
- exhaled nitric oxide unproven

Question 5

what is NICE asthma

for children

Answer 5

spirometry
BDR - bronchodilator
feNO
peak flow

Question 6

what is the BTS/SIGN guideline

Answer 6

same as NICE

Question 7

what is an asthma cough like in kids

Answer 7

dry
usually nocturnal
exertional

Question 8

how do you prevent a false positive response to treatment

Answer 8

use inhaler for 2 months then take a break to see if it was rly the treatment that helped symptoms

Question 9

what is the onset of ‘asthma under 5 years

Answer 9

congénital 
CF
PCD
bronchitis 
foreign bodyv

Question 10

what is onset of ‘asthma’ ‘for over 5s

Answer 10

dysfunctional breathing
vocal cord dysfunction
habitual cough
pertussis

Question 11

what is atophy

Answer 11

the body’s predisposition to develop an antibody called igE in response to exposure to environmental allergens and is an inheritable trait

Question 12

what does maternal smoking during pregnancy do

Answer 12

decrease FEV1

increase wheezy illness, airway responsiveness and asthma

Question 13

what are proven rick factors for asthma

Answer 13

smoking when pregnant
occupation 
obesity 
diet
hygiène

Question 14

what are some examples of triggers

Answer 14

exercise 
cold air 
smoke
perfume 
urtis 
pets
tree or pollen
good
drugs

Question 15

what are important aspects of history to understand

Answer 15

past med history
what drugs they take (inhalers)
family history - anyone got it
social history - pets or tobacco

Question 16

what can indicate asthma in examination

Answer 16

breathlessness on exertion
hyper inflated chest
wheeze

Question 17

what else could it be ?

Answer 17

COPD 
bronchiectasus 
cystic fibrosis
tumour or foreign body
cardiac

Question 18

what i vestigations can be done

Answer 18

full pulmonary function testing - carbon monoxide gas transfer - determine between COPD and asthma
reversibility to bronchodilator
variability of airflow obstruction

Question 19

what are other useful investigations

Answer 19

chest x-ray
skin prick testing
total abs specific igE
full blood count

Question 20

what signs do u assess for severity

Answer 20

ability to speak 
heart rate
respiratory rate
PEF 
oxygen saturation/arterial blood gases

Question 21

what are life threatening signs

Answer 21

grunting 
impaired comsciousness, confusion or exhaustion
bradycardia, arrhythmia or hypotension 
PEF<33% predicted
cyanosis 
silent chest
poor resp effect
saO2 <92% 
paO2 <8kPa 
paCO2 normal (4.6-6kPa) 

NEAR FATAL - raised paCO2 and need for mechanical ventilation