Asthma Clinical Features in Adults

Question 1

What is 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 change in severity either spontaeously or a result of therapy

Question 2

What is an important indicator of asthma, in terms of symptoms?

Answer 2

Variability of symptoms

Question 3

What does asthma result in?

Answer 3

Widespread narrowing of the airways

Question 4

What percentage of children have asthma?

Answer 4

10-15%

Question 5

What percentage of adults have asthma?

Answer 5

5-10%

Question 6

Are most children with asthma male or female?

Answer 6

Male

Question 7

Are most adults with asthma male or female?

Answer 7

Female

Question 8

How many people in the UK are recieving asthma treatment?

Answer 8

5.4 million

Question 9

How many children in the UK are recieving asthma treatment?

Answer 9

1.1 million

Question 10

How many adults in the UK are recieving asthma treatment?

Answer 10

4.3 million

Question 11

How often does somebody have a life threatening asthma attack?

Answer 11

Every 10 seconds

Question 12

What kinds of everyday things are totally or very limited by asthma?

Answer 12

Running

Sport

Stairs

Pets

DIY

Gardening

Pub

Waling

Sleeping

Question 13

How many admissions of asthma are there a year?

Answer 13

67,000

Question 14

How many bed days per year does asthma use?

Answer 14

220,000

Question 15

How many GP consulations are about asthma?

Answer 15

4.1 million

Question 16

What is the total cost of asthma to the NHS?

Answer 16

£889 million

Question 17

What is the total cost of asthma to the economy, due to productivity and benefits?

Answer 17

£1460 million

Question 18

What is the total cost of asthma to the economy and the NHS?

Answer 18

£2.349 billion

Question 19

How many working days a year are lost due to asthma?

Answer 19

12.7 million days

Question 20

How has asthma prevalence changes over the last 60 years?

Answer 20

Increased massively until about 2010 when it began to drop

Question 21

What are some proven risk factors for asthma?

Answer 21

Genetics

Occupation

Smoking

Question 22

What is atopy?

Answer 22

Inherited tendency to IgE response to allergens

Question 23

If your mother has asthma how much more at risk are you than if your father had it?

Answer 23

3x

Question 24

How much of adult onset asthma is due to occupation?

Answer 24

Underestimated at 10-15%

Question 25

What kinds of things are people exposed to at work that leads to asthma?

Answer 25

Isocyanates (paint) Colophony (welding) Laboratory animals Grains Enzymes Drugs Crustaceans (shell fish)

Question 26

What effect does maternal smoking during pregnancy have on the babies breathing?

Answer 26

Decreases FEV₁ Increases wheezy illness Increases airway responsiveness Increases asthma Increases severity

Question 27

What is the 'grandmother effect'?

Answer 27

If your grandmother smoked you are more at risk of asthma

Question 28

What are some possible risk factors of asthma?

Answer 28

Obesity Diet Reduced exposure to microbes Indoor pollution (chemical household products)

Question 29

What kind of things in someones diet increases the risk of asthma?

Answer 29

Less antioxidants Less n-3 polyunsaturated fatty acids More n-6 polyunsaturated fatty acids More and less vitamin D

Question 30

Why do we know reduced exposure to microbes might increase the risk of asthma?

Answer 30

Children born on farms are less likely to develop asthma

Question 31

How do we know indoor pollution might increase the risk of asthma?

Answer 31

Cleaners are more at risk of developing asthma

Question 32

What are some environmental allergens linked to asthma?

Answer 32

House dust mite Cat Grass pollen

Question 33

What is it important to remember about the link between allergens and asthma?

Answer 33

Exposure to allergens does not cause atopy or asthma, but factors associated with affluence increase the likelihood of sensitisation to local allergens

Question 34

What are some things that might cause localised airway obstruction?

Answer 34

Inspiratory stridor Tumour Forign body

Question 35

What are some things that might cause generalised airway obstruction?

Answer 35

Asthma COPD Bronchiectasis Bronchiolitis Cystic fibrosis

Question 36

What is most important for making the asthma diagnosis?

Answer 36

History, examination is rarely useful

Question 37

What are some symptoms of asthma?

Answer 37

Wheeze Short of breath Chest tightness (pain) Cough, usually dry Sputum (occasionally)

Question 38

What does an asthma sufferer bringing up green spit mean?

Answer 38

Not always an infection, neutrophils and polymorphs from inflammation also cause this

Question 39

What are some different things that could trigger asthma?

Answer 39

Exercise Cold air Smoke Perfume Pets Trees Grass pollen Food Asparin

Question 40

When may symptoms vary?

Answer 40

At different times, there could be: Daily variations (nocturnal/morning) Weekly variations (occupation, better at weekends) Annual variations (environmental allergens)

Question 41

What does asthma often show during an examination?

Answer 41

Breathless on exersion Hyperexpanded chest Polyphronic wheeze

Question 42

What if seen on examination suggests it is not asthma?

Answer 42

Clubbing, cervical lymphadenopathy Stridor Asymmetrical expansion Dull percussion note (lobar collapse, effusion) Crepitation (bronchiectasis, CF, alveolitis, LVF)

Question 43

What is crepitation?

Answer 43

A crackling sound

Question 44

What does it mean if the examination is normal?

Answer 44

It fits with asthma

Question 45

What does it mean if the examination is abnormal?

Answer 45

It does not fit with asthma

Question 46

What are we looking for in investigations to prove it is asthma?

Answer 46

Airway obstruction Variability and/or reversibility of airway obstruction

Question 47

What is the first investigation we do for asthma?

Answer 47

FEV₁ testing (spirometry)

Question 48

What do we do if spirometry testing for FEV₁ is normal?

Answer 48

Test variability of airflow obstruction using a peak flow meter and chart twice daily for two weeks Variability suggests asthma

Question 49

If the FEV₁ testing is normal, how often and for how long is a peak flow meter used to test variability of airflow obstruction?

Answer 49

Twice daily for 2 weeks

Question 50

What do we do if the spirometry testing FEV₁ shows obstruction?

Answer 50

1) Full pulmonary testing 2) Reversibility to bronchodilator 3) Reversibility to corticosteroids

Question 51

What does full pulmonary testing exclude?

Answer 51

COPD/emphysema Increase gas transfer suggests asthma, decreased suggests COPD

Question 52

When does full pulmonary testing suggest asthma?

Answer 52

If increase gas transfer

Question 53

What is the process of testing reversibility to bronchodilator?

Answer 53

1) Take baseline measurement 2) Give salbutamol 3) Compare the difference

Question 54

When does testing the reversibility to bronchodilator suggest asthma?

Answer 54

Increase in FEV₁ after salbutamol suggests asthma, no increase suggests COPD

Question 55

How much of an increase suggests asthma when testing reversibility to bronchodilator?

Answer 55

More than 12%

Question 56

When testing reversibility to oral corticosteroids, what suggests asthma?

Answer 56

Improvement suggests reversibility so asthma, no improvement suggests COPD

Question 57

What is the FEV₁/FVC ratio for an airway obstruction?

Answer 57

Less than 70%

Question 58

What might suggest occupational asthma?

Answer 58

Suspicion from work related symptoms Working with recognised occupational sensitiser

Question 59

How is occupational asthma confirmed?

Answer 59

Serial peak flow readings, 2 hourly best for 2 days minimum Difference in and out of work shows occupational asthma

Question 60

What are examples of specialised investigations?

Answer 60

Airway responsiveness to methacholine/histamine Exhaled nitric oxide

Question 61

What are some additional useful investigations?

Answer 61

Chest x-ray Skin prick testing Total and specific IgE Full blood count

Question 62

What could a chest x-ray of someone with asthma show?

Answer 62

Hyperinflated, hyperlucent No effusion, collapse, opacities, interstitial changes

Question 63

What does skin prick testing, total and specific IgE and full blood count test?

Answer 63

Atopic status

Question 64

Why is being objective more important than subjective?

Answer 64

Life threatening asthma may not induce any visible distress

Question 65

What physiological indicators are checked when dealing with asthma?

Answer 65

Ability to speak Heart rate Respiratory rate PEF Oxygen saturation/arterial blood gases

Question 66

What is acute asthma?

Answer 66

Flare up of asthma

Question 67

What are the different kinds of acute asthma?

Answer 67

Mild Severe Life threatening Near fatal

Question 68

What are the physiological values for mild asthma?

Answer 68

Able to speak, complete sentances Heart rare \< 110 RR \< 25 PEF 50-75% SaO₂ \> 92% PaO₂ \> 8kPa

Question 69

What are the physiological values for severe asthma?

Answer 69

Unable to speak, unable to complete sentences HR \> 110 RR \>25 PEF 33-50% SaO₂ \> 92% PaO₂ \> 8kPa

Question 70

What are the physiological values for life threatening asthma?

Answer 70

Grunting Impaired consciousness, exhaustion HR \> 130 or bradycardiac Hypoventilating PEF \< 33% Cyanosis SaO₂ \< 92% PaO₂ \< 8kPa PaCO₂ normal (4.6 - 6kPa)

Question 71

What physiological value is for near fatal asthma?

Answer 71

Raised PaCO₂

Question 72

What does near fatal asthma require?

Answer 72

Mechanical ventilation

Question 73

What is bradycardia?

Answer 73

Slower heartrate than normal

Question 74

What is cyanosis?

Answer 74

Discolourisation to the skin