Clinical features of Asthma

Question 1

What are the clinical features of Asthma?

Answer 1

Disease or Syndrome for which there is no universally accepted definition.
Increases responsiveness of the trachea and bronchi to various stimuli.
Widespread narrowing of airways.

Question 2

What are Symptoms of asthma?

Answer 2

Wheezing, Coughing, Shortness of breath, chest tightness together with difficulty in expiration.

Question 3

Why is asthma important?

Answer 3

Common, Dangerous, Expensive

Question 4

What is the scale of asthma in the UK?

Answer 4

5.4 million people living with asthma.

3 families affected everyday with a death due to asthma.

Question 5

In children, is asthma more common in males or females?

Answer 5

Males

Question 6

In adults, is asthma more common in males or females?

Answer 6

Females

Question 7

What happens to airways during an asthmatic attack?

Answer 7

Air is trapped in the alveoli.

Tightened smooth muscle. Wall inflames and thickened.

Question 8

What are the proven risk factors of Asthma?

Answer 8

Hereditary, smoking, occupation

Question 9

Explain the hereditary risks of asthma.

Answer 9

Disease clusters in families.

Risk increased with 1st degree family members or other atopic diseases.

Question 10

What is Atopy?

Answer 10

Bodies predisposition to develop an antibody called immunoglobulin E in response to exposure to environmental allergens and is an inheritable trait.

Question 11

What is atopy associated with?

Answer 11

Allergic rhinitis, asthma, hay fever, eczema.

Question 12

What does maternal smoking during pregnancy cause?

Answer 12

Decreased Forced expiratory volume. Increased Wheeze, airway responsiveness and asthma.

Question 13

What are the occupational risks?

Answer 13

Isocyanates (paint), Colophony (welding), Lab animals, grains, enzymes, Drugs, Crustaceans.

Question 14

What are other possible risks of asthma?

Answer 14

Obesity, diet, ‘hygiene hypothesis’

Question 15

What are the clinical aspects of asthma?

Answer 15

History most important. Investigations can be supportive. NO single test.

Question 16

What signs can you look for in diagnosis.

Answer 16

Recurrent episodes, Absence of other symptoms, wheeze, personal history of atopy, variable FEV, sputum (occasionally), Cough (Usually dry)

Question 17

What variations are common in Asthma?

Answer 17

Daily variation (night/morning),
Weekly (Occupation/better at weekends/holiday), Annual (environmental allergens)

Question 18

What are common triggers?

Answer 18

Exercise, cold air, cigarette smoke, perfumes, URTI, pets, tree or grass pollen, food, drugs (aspirin or NSAIDS)

Question 19

What are important aspects of PMH?

Answer 19

Childhood asthma, bronchitis or wheeze. Eczema. Hayfever.

Question 20

Important aspects of Drugs?

Answer 20

Current inhalers and compliance, B-blockers, Aspirin, NSAIDS, effect of previous drugs.

Question 21

Importance of Social history?

Answer 21

Tobacco, recreational drugs, vaping, Pets, occupation, psychological aspects.

Question 22

Clinical examination for Asthma diagnosis?

Answer 22

Breathlessness on exertion, Hyperinflated chest, Wheeze

Question 23

Probably not asthma if…

Answer 23

Finger clubbing, Stridor, Asymmetrical expansion, dull percussion note, Crepitations

Question 24

If not asthma, what else?

Answer 24

COPD, Bronchiectasis, Cystic fibrosis, Tumour, foreign body

Question 25

Explain a spirometry test?

Answer 25

Rather FEV values. If the volume is reduced then the airways are obstructed. However peak may be completely normal and still have asthma.

Question 26

If airways are obstructed, what other test can be carried out? and what does it exclude?

Answer 26

Full pulmonary function testing with CO transfer to Hb. Decreased think of COPD. (excludes COPD/emphysema)

Question 27

What is a reversibility test?

Answer 27

Response to bronchodilator using salbutamol. Significant reversibility = >12 baseline

Question 28

What are oral corticosteroids?

Answer 28

Anti-inflammatory - separates COPD from asthma.

Question 29

If Spirometry is normal, what tests can be carried out?

Answer 29

Peak flow meter and chart, twice daily for 2 weeks. Look for morning/night dips.

Question 30

What are other specialist investigations that can be carried out?

Answer 30

Airway responsiveness to Mathacholine, Histmine and mannitol. Exhaled Nitric oxide (FeNO)

Question 31

What are other useful investigations?

Answer 31

Chest x-ray, skin prick (atopy) Total and specific IgE, Full blood count (eosinophilia)

Question 32

Features of Moderate Asthma?

Answer 32

Able to speak. HR<110, RR<25, PEF (peak expiratory flow) 50-70% predicted or best, SaO > 92%, PaO > 8kPa

Question 33

Features of Severe Asthma?

Answer 33

Inability to complete sentences in one breath. HR > 110. RR >25, PEF 33-50% predicted or best. SaO > 92%. PaO > 8kPa

Question 34

Features of life threatening asthma?

Answer 34

Grunting, Impaired consciousness, confusion, exhaustion. Bradycardia, arrythmia, hypotension.
PEF < 33%. Cyanosis, Silent chest, poor respiratory effort.
SaO < 92%. PaO < 8kPa. PaCO normal

Question 35

Near fatal symptoms?

Answer 35

Raised PaCO2, need for mechanical ventilation.

Question 36

Main Points?

Answer 36

Symptoms variable and intermittent.
Demonstrate airway obstruction.
Reversibility to bronchodilators and corticosteroids.
Variable airflow obstruction: Peak Flow chart.