CHRONIC ASTHMA

Question 1

What are the symptoms of Chronic Asthma?

Answer 1

Episodic symptoms

Diurnal variability (worse at night)

Dry cough

Dyspnoea

History of atopic condition

Bilateral polyphonic wheezing

Question 2

How is chronic asthma investigated with BTS/SIGN GUIDELINES?

Answer 2

High Probability > try treatment

Intermediate Probability > perform spirometer with reversibility testing

Low Probability > consider referral and investigating other causss

Question 3

What is NICE first line investigation for Chronic Asthma?

Answer 3

Fractional Exhaled NO: high (33ppb)

Spirometer with bronchodilator reversibility: positive = FEV1/FEV <70% ; FEV1 increases by >12% or 200ml

Question 4

What is the Further testing NICE advices you to do for Chronic Asthma?

Answer 4

Peak Flow variability: Positive = >20% variability (recorded daily for 2-4weeks)

Direct Bronchial Challenge Test with histamine or methacholine: positive

Question 5

What is the BTS thoracic society guideline for Chronic Asthma management?

Answer 5

STEP1: SABA

STEP2: + low dose inhaled steroid (Prednisolone)

STEP3: + inhaler LABA or Oral Theophylline or increase inhaled Steroid

STEP4: trial of inhaled steroid, theophylline, oral BA or inhaled LAMA

STEP5: + titrate corticosteroid up to highest dose

STEP6: + lowest dose of oral steroid