Clinical Features Of Asthma

Question 1

Describe the clinical manifestations of.

Answer 1

Patients typically complain of symptoms including shortness of breath, wheeze, cough, and chest tightness, which tend to be worse at the beginning or end of the day.

Question 2

Why is asthma considered important?

Answer 2

Asthma is common, dangerous, and expensive, with millions affected, several deaths daily, and significant impact on healthcare resources and the economy.

Question 3

What are the prevalence rates of asthma in the UK?

Answer 3

In the UK, around 5.4 million patients are affected by asthma, with higher prevalence in childhood (10-15% mostly males) and adulthood (5-10% mostly females).

Question 4

How has the prevalence of asthma-related diseases changed over the years?

Answer 4

The prevalence has significantly increased until about 20 years ago, and although it’s now leveling off, these diseases are much more common than several decades ago.

Question 5

What are the implications of asthma on the healthcare system?

Answer 5

Asthma leads to 70,000 hospital admissions each year, with an average bed stay of just under four days, putting pressure on hospitals, GPs, and primary care.

Question 6

Define the pathophysiology of asthma.

Answer 6

Asthma is a disease of the lung airways resulting from widespread narrowing of the airways and increased airway reactivity, causing further narrowing spontaneously and in response to specific stimuli.

Question 7

What are some of the risk factors for asthma?

Answer 7

Risk factors for asthma include genetic predisposition, environmental factors, respiratory infections, and exposure to allergens and irritants.

Question 8

Describe the genetic predisposition to asthma.

Answer 8

Some people have a genetic predisposition to asthma, supported by disease clustering within families, twin family and population-based studies.

Question 9

What is ETP and how is it associated with asthma?

Answer 9

ETP is the body’s predisposition to develop an antibody called immunoglobulin E (IgE) in response to exposure to environmental allergens. It is associated with allergic rhinitis, asthma, hay fever, and other atopic diseases.

Question 10

Do first-degree family members influence the risk of asthma?

Answer 10

Yes, the risk of asthma is increased if a first-degree family member has asthma or another atopic disease, with maternal influence being the most important.

Question 11

Define epigenetics and its role in asthma risk.

Answer 11

Epigenetics is a phenomenon where environmental triggers, such as tobacco smoke, switch on genes that increase asthma risk in subsequent generations.

Question 12

How can certain jobs or occupations cause asthma?

Answer 12

Exposure to different allergens in certain jobs can cause occupational asthma, especially in atopic individuals and those who smoke.

Question 13

Describe the potential risk factors linked to the development of asthma.

Answer 13

Potential risk factors include obesity, changes in diet, and the hygiene hypothesis, which suggests that growing up in sterile environments may contribute to asthma development.

Question 14

Describe the suggested algorithm forosing asthma according to the British Thoracic Society guidelines.

Answer 14

The suggested algorithm for diagnosing asthma involves considering cyst symptoms, obtaining a detailed history of presenting symptoms, and identifying symptom variability throughout the day, week, and seasons.

Question 15

How is the diagnosis of asthma in adulthood typically made?

Answer 15

The diagnosis of asthma in adulthood is primarily based on obtaining a reliable and detailed history from the patient, supported by investigations, as there is no single test that can confidently diagnose or exclude asthma.

Question 16

Define the term ‘symptom variability’ in the context of asthma diagnosis.

Answer 16

Symptom variability refers to the fluctuation of asthma symptoms throughout the day, week, and seasons, as well as in response to different triggers and exposures.

Question 17

What are some key symptoms that patients with asthma often present with?

Answer 17

Patients with asthma often present with wheeze, cough, breathlessness, chest tightness, and may bring up green or yellow sputum, which does not necessarily indicate infection.

Question 18

Do investigations play a crucial role in diagnosing asthma?

Answer 18

While investigations can be supportive, there is no single test that can confidently diagnose or exclude asthma, making the patient’s history the most important factor in diagnosis.

Question 19

Describe the potential triggers that can aggravate asthmatic symptoms.

Answer 19

Potential triggers for asthmatic symptoms include exercise, cold air, cigarette smoke, perfumes, strong scents, respiratory tract infections, pets, tree or grass pollen, certain foods, and certain drugs such as aspirin and nonsteroidal anti-inflammatory drugs.

Question 20

How does symptom variability manifest in patients with asthma?

Answer 20

Symptoms of asthma can vary throughout the day, week, and seasons, and may be influenced by factors such as occupational exposure, allergic triggers, and individual responses to specific triggers.

Question 21

What is the significance of obtaining a detailed history from a patient with suspected asthma?

Answer 21

Obtaining a detailed history is crucial in diagnosing asthma as it helps in identifying presenting symptoms, potential triggers, and the variability of symptoms, as well as ruling out alternative diagnoses.

Question 22

How does the color of sputum in asthmatic patients relate to infection?

Answer 22

The color of sputum in asthmatic patients, which can be green or yellow, does not always indicate bacterial or viral infection, as it can be caused by inflammatory cells associated with asthma.

Question 23

Define the term ‘occupational asthma’ and its impact on symptom variability.

Answer 23

Occupational asthma refers to asthma triggered by substances in the workplace, and symptoms may improve when the individual is away from their place of work, such as at home or on holidays.

Question 24

Describe the importance of inquiring about a patient’s past medical history in relation to asthma diagnosis.

Answer 24

It helps to identify any history of asthma, childhood bronchitis, wheezing, atopic diseases like eczema or hay fever, and the use of medications that can aggravate asthma symptoms.

Question 25

What aspects of a patient’s medication usage should be considered when assessing for asthma?

Answer 25

It’s important to know what medications the patient is on, whether they are using their inhalers, if they are using their inhalers appropriately, and what medications have been trialed for their symptoms and asthma.

Question 26

How can family history be relevant in the assessment of asthma?

Answer 26

Family history can help identify any genetic predisposition to asthma or other atopic diseases, as asthma and atopic diseases can run in families.

Question 27

Define the role of social history in assessing potential triggers for asthma.

Answer 27

Social history helps to identify potential triggers such as tobacco smoke, recreational drug use, vaping, pets, occupations, and stress, which can worsen asthma symptoms.

Question 28

What are some potential findings during a clinical examination that may point to an alternative diagnosis to asthma?

Answer 28

Findings such as finger clubbing, cervical lymphadenopathy, stridor, asymmetrical expansion, dull percussion note, or crepitation on listening to lungs may point to alternative diagnoses like lung cancer, foreign body obstruction, lung collapse, pleural effusion, pneumonia, bronchiectasis, cystic fibrosis, interstitial lung disease, or left ventricular failure.

Question 29

Describe the next steps in the assessment of patients with a high probability of asthma and those with a low probability of asthma.

Answer 29

For patients with a high probability of asthma, treatment is initiated and their response is assessed. For patients with a low probability of asthma, alternative diagnoses are investigated accordingly.

Question 30

Describe the purpose differentiating other causes wheeze,, and breathlessness patients with low clinical suspicion of asthma.

Answer 30

The purpose is to give another diagnosis to explain these symptoms differentiate other potential causes of airflow obstruction.

Question 31

Define COPD and explain how it differs from asthma.

Answer 31

COPD stands for chronic obstructive pulmonary disease and is characterized by irreversible airflow obstruction, unlike asthma which typically features reversible airflow obstruction.

Question 32

Describe what Stridor is and how it differs from expiratory wheeze.

Answer 32

Stridor is an inspiratory wheeze caused by obstruction of the large airways, which contrasts with expiratory wheeze typically associated with asthma.

Question 33

How does cardiac causes such as heart failure or valvular heart disease contribute to wheeze, cough, and shortness of breath?

Answer 33

These conditions can lead to symptoms of wheeze, cough, and breathlessness, indicating that the problem may not be with the lungs but with the heart.

Question 34

Do patients with an intermediate probability of asthma require further tests and investigations?

Answer 34

Yes, it is quite likely that further tests and investigations might be helpful in these cases.

Question 35

Describe the purpose of spirometry in clinical and general practice.

Answer 35

Spirometry is used to assess forced expiration and measure parameters such as FEV1 (forced expiratory volume in one second) and FVC (forced vital capacity) to evaluate lung function.

Question 36

What does a ratio of FEV1 over FVC less than 70% indicate in spirometry?

Answer 36

It indicates airflow obstruction, as the patient is not exhaling 70% of the full lung capacity in the first second of expiration.

Question 37

How does normal spirometry relate to the diagnosis of asthma?

Answer 37

Normal spirometry does not exclude asthma, as asthma is variable and may not always be reflected in spirometry results. Asthmatic patients may have obstructive spirometry or entirely normal spirometry.

Question 38

Describe two scenarios when a patient with possible asthma may have obstructive spirometry or normal spirometry.

Answer 38

A patient with possible asthma may have obstructive spirometry if symptomatic, but they may also have normal spirometry, even if they have evidence of airflow obstruction.

Question 39

Describe the process of reversibility testing in suspected asthma patients.

Answer 39

Reversibility testing involves checking the FEV1 before and after inhaled or nebulized dose of a bronchodilator like salbutamol to see if there’s a significant improvement, which would be consistent with asthma.

Question 40

What is the purpose of gas transfer testing in suspected asthma patients?

Answer 40

Gas transfer testing measures the gas transfer of carbon monoxide to hemoglobin and can help differentiate between COPD and asthma, as it is preserved or increased in asthma but reduced in COPD.

Question 41

How can variability of airflow obstruction be demonstrated in patients with possible asthma and normal spirometry?

Answer 41

Patients are asked to record peak flow measurements at least twice daily for two weeks, looking for variability of greater than 20% over these recordings, which can be supportive of asthma.

Question 42

Define the sawtooth pattern in peak flow measurements and its significance in diagnosing asthma.

Answer 42

The sawtooth pattern is caused by morning dips in peak flow and can be very suggestive of asthma when observed in the peak flow recordings.

Question 43

Describe the use of specialist tests like Methacholine, Histamine, or Mannitol in diagnosing asthma.

Answer 43

These tests involve asking patients to breathe in certain chemicals at gradually increasing doses to stimulate responsiveness in asthmatic individuals and cause their FEV1 to drop off in patients with asthma.

Question 44

What are the potential implications of a significant and continual improvement in peak flow measurements after giving oral corticosteroids to a patient with possible asthma?

Answer 44

It suggests stellar responsiveness and reversibility, helping distinguish asthma from COPD.

Question 45

Describe the technique exhaled nitric oxide and its use measuring airway inflammation in asthmatic individuals.

Answer 45

Exhaled nitric oxide is a technique used as breathalyzer to measure airway inflammation in asthmatic individuals. High levels of exhaled nitric oxide indicate evidence of inflammation, which is consistent with asthma.

Question 46

Define FeNO and its significance in asthma diagnosis.

Answer 46

FeNO refers to exhaled nitric oxide, which is used as a marker for airway inflammation in asthma. High FeNO levels indicate evidence of inflammation, which is associated with asthma.

Question 47

How is chest X-Ray used in diagnosing asthma and what specific findings are important to exclude other causes of symptoms?

Answer 47

Chest X-Ray is used in diagnosing asthma to identify hyperinflated and hyperlucent lung fields. It is important to exclude pleural effusions, consolidations (pneumonia), lung collapse, lung cancer, and changes consistent with interstitial lung disease.

Question 48

Describe the usefulness of skin prick testing and total and specific IgEs in identifying atopic individuals and their association with asthma.

Answer 48

Skin prick testing and total and specific IgEs are useful in identifying atopic individuals, which can be associated with asthma. Elevated levels of specific IgEs are often found in individuals with asthma.

Question 49

What are the physiological signs used to assess the severity of an acute episode of asthma?

Answer 49

The physiological signs used to assess the severity of an acute episode of asthma include the ability to speak, heart rate, respiratory rate, PEF flow, and oxygen saturations or arterial blood gas measurements.

Question 50

Describe the grading system for the severity of an asthma attack and the clinical features associated with each category.

Answer 50

The severity of an asthma attack is graded as moderate, severe, life-threatening, or near-fatal. The severity is determined based on the presence of specific clinical features that place the attack in a particular category.

Question 51

Describe the criteria for life-threatening asthma.

Answer 51

Life-threatening asthma is characterized by features such as grunting, impaired consciousness, cardiovascular instability, low PEF flow, cyanosis, silent chest on auscultation, and poor respiratory effort.

Question 52

What are the indicators of near-fatal asthma?

Answer 52

Near-fatal asthma is indicated by high carbon dioxide levels, the need for mechanical ventilation or life support, and the failure of ventilatory drive.

Question 53

Define the respiratory rate threshold for identifying severe asthma.

Answer 53

A respiratory rate above 25 is indicative of severe asthma.

Question 54

How is life-threatening asthma differentiated from less severe categories based on arterial oxygenation?

Answer 54

Life-threatening asthma is characterized by arterial oxygenation levels less than 92%, while less severe categories typically have higher oxygenation levels.

Question 55

Do patients with life-threatening asthma typically exhibit hyperventilation?

Answer 55

No, patients with life-threatening asthma may have normal carbon dioxide levels, indicating a lack of hyperventilation.

Question 56

Describe the role of arterial blood gas testing in assessing asthma severity.

Answer 56

Arterial blood gas testing is mandated if oxygen levels are less than 92%, or if the patient’s arterial oxygenation level is less than eight.

Question 57

What are the signs of cardiovascular instability in life-threatening asthma?

Answer 57

Signs of cardiovascular instability in life-threatening asthma include bradycardia, cardiac arrhythmia, and hypertension.

Question 58

How is the PEF flow used to categorize asthma severity?

Answer 58

A PEF flow drop to 33-50% of the predicted best indicates severe asthma, while a drop below 33% suggests life-threatening asthma.

Question 59

Describe the characteristics of patients with near-fatal asthma.

Answer 59

Patients with near-fatal asthma are at higher risk of mortality, have high carbon dioxide levels, and may require mechanical ventilation or life support.