Clinical Features of Asthma in Adulthood

Question 1

What are the two outcomes of airway inflammation thats mediated by the immune system

Answer 1

1. widespread narrowing of airways
2. increased airway reactivity = airway narrowing = spontaneously OR stimuli

Question 2

Risk factors for asthma

Answer 2

HEREDITARY - mainly maternal
SMOKING
OCCUPATION

Question 3

Symptoms of asthma

Answer 3

• Wheezing
• Coughing
• Shortness of breath
• Chest tightness
• Together with difficulty in expiration

Question 4

Evidence of variable asthmatic symptoms

Answer 4

• Daily variation (nocturnal/ early morning)
• Weekly variation (occupation, better at weekends & holidays)
• Annual variation (environmental allergens)

Question 5

Asthmatic triggers

Answer 5

• Exercise
• Cold air
• Cigarette smoke
• Perfumes/ strong scents
• URTI’s
• Pets
• Tree or grass pollen
• Food
• Drugs (aspirin/ NSAIDS)

Question 6

If its not asthma what else could it be?

Answer 6

Really trying to differentiate from other causes of wheeze, cough & dyspnoea

• Generalised airflow obstruction
  
  • COPD (irreversible AFO)
  • Bronchiectasis
  • Cystic Fibrosis
• Localised airway obstruction (inspiratory stridor= large airways)
  
  • Tumour
  • Foreign body
• Cardiac

Question 7

What are we looking for evidence of when investigating for asthma

Answer 7

Airflow obstruction OR Variability and/or reversibility of airway obstruction

Question 8

Assessing severity of acute asthma

Answer 8

• Life threatening asthma may not induce distress
• Doctors, patients, relatives underestimate
• Subjective parameters not reliable

Objective >subjective

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

Question 9

Assessing severity of moderate asthma

Answer 9

Essentially increasing symptoms, no features of acute severe

• Able to speak, complete sentences
• HR < 110
• RR < 25
• PEF 50 - 75% predicted or best
• SaO2 ≥ 92% (no need for ABG)
• PaO2 ≥ 8kPa

Question 10

Assessing severity of SEVERE asthma

Answer 10

Any one of

• Inability to complete sentences in one breath
• HR ≥110
• RR ≥25
• PEF 33 - 50% predicted or best
• SaO2 ≥ 92%
• PaO2 ≥ 8kPa

Question 11

Assessing severity of LIFE THREATENING asthma

Answer 11

Any one of

• Grunting
• Impaired consciousness, confusion, exhaustion
• Bradycardia/ arrhythmia/ hypotension
• PEF < 33% predicted or best
• Cyanosis
• Silent chest
• Poor respiratory effort
• SaO2 < 92% (definitely needs blood gas!)
• PaO2 < 8kPa
• PaCO2 normal (4.6 - 6.0kPa)