Asthma & Co

Question 1

Features of asthma?

Answer 1

• cough - worse at night, on exertion, cold air, emotions
• end expiratory wheeze
• dyspnoea
• other features of atopy (eczema, hayfever)

Question 2

What tests are important for asthma?

Answer 2

• Fraction expired Nitrous Oxide (FeNO) >35-45
• FEV1 bronchoreversibility increase FEV1 of 12%
• FEV1/FVC <70%

Question 3

treatment ladder for asthma?

Answer 3

-avoid triggers/improve inhaler technique

• SABA
• SABA + ICS
• SABA + ICS + LTRA (assess response in 4-8/52)
• SABA + ICS + LABA (+LRTA if responsive)
• start swapping to combination inhalers
• increase ICS stepwise

Question 4

What symptoms would suggest a life-threatening attack of acute asthma?

Answer 4

33, 92, CHEST 
PEF <33% expected 
<92% O2 sats 
Cyanosis
Hypotension 
Exhaustion/confusion/altered states if consciousness
Silent chest 
Tachy/dysrhythmias

Question 5

What would be considered a severe acute asthma attack?

Answer 5

• can’t talk in full sentences
• PEF 33-50%
• HR >110
• RR>25

Question 6

What investigation result would indicate an exhaustion brewing?

Answer 6

increased PaCO2 on ABG - not puffing it off anymore

Question 7

How do you manage an acute asthma attack?

Answer 7

O SHIT ME

Oxygen

Salbutamol nebuliser 5mg (4 times B2B each over 15 mins)
Hydrocortisone 100mg IV
Ipatropium bromide 500mcg (can mix with salbutamol)
Theophylline (from here downwards get senior help)
Magnesium Sulphate
Endotracheal tube

Question 8

What is EAA? and it’s other name? What are the symptoms?

Answer 8

extrinsic allergic alveolitis OR hypersensitivity pneumonitis

Can be acute or chronic

Acute = w/in 4-8 hours of exposure

• dyspnoea
• dry cough
• fever

Chronic = 6-8 weeks after exposure

• lethargy
• dyspnoea
• productive cough
• weight loss

Question 9

What are some causes of extrinsic allergic alveolitis?

Answer 9

• bird fanciers lung (pigeon shit protein allergy)
• malt workers lung (grain handling)
• mushroom workers lung
• farmers lung

Question 10

What specific test would differentiate EAA from asthma?

Answer 10

blood tests w/ eosinophilia = asthma

w/o eosinophilia = more likely EAA

Question 11

What tests would you run for query EAA?

Answer 11

• bloods - eosinophilia + IgG assay
• bronchoalveolar washout and lavage
• sputum culture
• Feno
• CXR then maybe CT

Question 12

How does one treat EAA?

Answer 12

avoid trigger where possible

oral steroids

Question 13

What things can you inhale that would cause an occupational lung disorder (OLD)?

Answer 13

• Dust -stone, wood
• Fumes - soldiering, welding
• Mists - metal working fluid (machinist - what do you mean?)

Question 14

What is important for diagnostics when considering OLD?

Answer 14

PEF at work and away from work to see if there is correlation to results & differing Sx