Asthma Clinical Features-adults

Question 1

what is the definition of asthma?

Answer 1

A disease characterised by an increased responsiveness of the trachea and bronchi to various stimuli and manifested by a widespread narrowing of airways that changes in severity either spontaneously or as a result of therapy

Question 2

what is airway reactivity in asthma?

Answer 2

propensity of the airways to narrow/shut either to stimuli or spontaneously.

Question 3

what are the main causes of airway obstruction?

Answer 3

• debris in the alveoli and airways such as mucous and cells
• constriction of smooth muscles around airways
• inflammation/thickening of the airway walls

Question 4

is asthma more prevalent in boys or girls?

Answer 4

boys

Question 5

is asthma more prevalent in men or women?

Answer 5

women

Question 6

why is asthma an important condition in the UK?

Answer 6

it is very common with 5.4 million people receiving treatment

Question 7

how has the prevalence of asthma in the last 30-40 years changed?

Answer 7

it has been becoming much more common

Question 8

what are the 3 proven risk factors for asthma?n whose mother smoked have a 50% increase in risk o

Answer 8

• family history of atopic asthma
• occupation
• smoking (of mother and grandmother)

Question 9

what is atopy?

Answer 9

Inherited tendency to IgE response to allergens

Question 10

does maternal or paternal atopic asthma cause the strongest risk of asthma in children?

Answer 10

maternal 3x more

Question 11

give some examples of occupations that will increase your risk of developing asthma

Answer 11

baker- wheat proteins and enzymes in air

welder- colophony in welding solder flux

Question 12

what is the ‘grandmother effect’?

Answer 12

children whose mother smoked have a 50% increase in risk of asthma. 100% increase maternal grandmother smoked. 150% increase if bothed smoked.

Question 13

what are some possible risk factors for asthma?

Answer 13

• obesity
• diet
• reduced exposure to microbes/microbial products
• indoors pollution: chemical household products
• environmental allergens eg. house dust mite and cat

Question 14

which other conditions can cause airway obstruction?

Answer 14

COPD
bronchiectasis
bronchiolitis
cystic fibrosis

Question 15

does allergen exposure cause asthma?

Answer 15

no, it is more to do with the way we live nowadays

Question 16

what is dyspnoea?

Answer 16

breathlessness

Question 17

what is a wheeze?

Answer 17

a high pitched whistling noise from the chest (not throat)

Question 18

what are the symptoms of asthma that you must look out for in the history?

Answer 18

• wheeze
• short of breath
• (dyspnoea), severity -chest tightness (pain)
• cough, paroxysmal, usually dry
• sputum (occasional)

Question 19

what is paroxysmal?

Answer 19

sudden intensification of symptoms

Question 20

what variations in symptoms must you look out for?

Answer 20

-triggers
- daily variation, nocturnal or early morning
-weekly variation (may be occupational)
annual variation (environmental allergens eg. grass pollen in summer)

Question 21

what are some triggers for asthma?

Answer 21

exercise, cold air, smoke, perfume, URTI’s, pets, tree, grass pollen, food, aspirin

Question 22

what PMH do you have to look out for for asthma?

Answer 22

childhood asthma, bronchitis

Question 23

what drugs do you have to look out for when taking a hitory?

Answer 23

• Current inhalers (micrograms, NOT puffs), check technique
• compliance (beta)-blockers
• aspirin
• NSAIDS (Non-steroidal anti-inflammatory drugs)
• Effects of previous drugs and inhalers

Question 24

what family history must you look out for asthma?

Answer 24

atopic disease

Question 25

what personal history is important for asthma?

Answer 25

• smoking
• pets
• occupations past/present (what job entails)
• psychosocial aspects (may cause poor asthma control)

Question 26

what are some observations in an examination of an asthmatic?

Answer 26

• breathless on exertion
• hyperexpanded chest
• polyphonic wheezes

Question 27

what signs should you look out for on examination which show it is probably not asthma?

Answer 27

-Clubbing
-cervical lymphadenopathy
-stridor
-assymetrical expansion
-Dull percussion note, (lobar collapse, effusion)
-Crepitations (crackling sound)
(bronchiectasis, CF, alveolitis, LVF)

Question 28

what is bronchiectasis?

Answer 28

a long-term condition where the airways of the lungs become abnormally widened, leading to a build-up of excess mucus that can make the lungs more vulnerable to infection.

Question 29

what are the two main things looked for in investigations?

Answer 29

• airway obstructive

- variabilty and/or reversibility of airflow obstruction

Question 30

what spirometry results are indicative of an obstructive airway disease?

Answer 30

FEV1 less than 80%
FEV1/FVC ratio less then 70%
may be competely normal though as in asthma airway obstruction is variable.

Question 31

what investigations should be carried out if there is evidence of an obstructed airway from the spirometry?

Answer 31

• full pulmonary function testing
• reversibility to bronchodilator
• reversibilty to oral corticosteroids

Question 32

what is full pulmonary function testing?

Answer 32

used after a obstructive picture from spirometry. Used to exclude COPD or emphysema. The two tests carried out are lung volumes by helium dilution and carbon monoxide gas transfer (transfer of CO to Hb across alveoli, this tests for tissue destruction.

Question 33

what is the reversibilty to bronchodilator test used for?

Answer 33

used after a obstructive picture from spirometry. It tests for bronchoconstriction. for significant reversibility the change in FEV1 must be greater than 200ml and greater the 15% of base line.

Question 34

for significant reversibility in reversibilty to bronchodilator test what results must be obtained?

Answer 34

the change in FEV1 must be greater than 200ml and greater the 15% of base line.

Question 35

what is the reversibilty to oralcorticoseroids test used for?

Answer 35

used to separate COPD from asthma when there is an obstructed picture from initial spirometry. It tests for inflammation in airways.

Question 36

what is the prescription for a reversibility to oral corticosteroid test and what is measured?

Answer 36

0.6mg/kg of prednisolone for 14 days. with peak flow chart and meter. spirometry, baseline and after 2 weeks

Question 37

what test must be carried out if initial spirometry results are normal?

Answer 37

to look for variability in airflow obstruction a peak flow meter and chart in performed twice daily for 2 weeks.

Question 38

what are some optional investigations for asthma that should be left to the specialist?

Answer 38

• airway responsivness to methacholine/ histamine/ mannitol/ exercise
• exhaled nitric oxide

Question 39

what are some useful extra investigations for asthma diagnosis?

Answer 39

• chest x-ray
• skin prik testing
• total and specific IgE
• full blood count

Question 40

what is a chest x-ray useful for when diagnosing asthma?

Answer 40

looking for hyperinflation, hyperlucent (less dense than normal)
or chcking for no effusion, collapse, opacities, interstitial changes

Question 41

what is skin prick testing useful for when diagnosing asthma?

Answer 41

looking for atopic status

Question 42

what is a total and specific IgE testing useful for when diagnosing asthma?

Answer 42

looking for atopic status

Question 43

what is a fill blood count useful for when diagnosing asthma?

Answer 43

looking for eosinophilia associated with atopy

Question 44

what are the features of an asthmatic in moderate condition?

Answer 44

able to speak and complete sentences
HR<110
RR<25
PEF 50-75%

Question 45

what are the features of an asthmatic in a severe condition?

Answer 45

unable to speak or complete sentences
HR>110
RR>25
PEF 33-50%

Question 46

what are the features of an asthmatic in a life threatening condition?

Answer 46

grunting
impaired consciosness, confusion, exhaustion
HR>130 or bradycardia when about to go into cardiac arrest
hypoventilating
PEF <33%

Question 47

when is an asthmatic in a near fatal condition?

Answer 47

when PaCO2 is raised