Condition - Asthma

Question 1

Clinical features

Answer 1

Symptoms:
Wheeze
Shortness of breath
Diurnal variation (worse at night when parasympathetic tone is predominant)
Precipitating factors - dust, cold, exercise

Signs:
Hyperventilation (acute)
Hyperinflation (possibly)
Diagnose from history and investigation

History:
Atopic triad - asthma, eczema, allergic rhinitis

Question 2

Investigation

Answer 2

Peak expiratory flow:
2 week recording twice a day to see diurnal variation
Before and after SABA to see if reversible

Spirometry:
Obstructive patten - FEV1 will be much lower than FVC

Skin prick tests:
Identify allergenic factors

Question 3

Treatment

Answer 3

Stepwise program, always start on SABA, if using more than 3 times a week or multiple times a day, step up.

Step 1: SABA when required
Step 2: add regular inhaled corticosteroid
Step 3: add regular LABA
Step 4: increase inhaled corticosteroid dose, consider other agents (leukotriene receptor antagonist - montelukast)
Step 5: oral steroids

Question 4

Differential diagnosis

Answer 4

Dyspnoea:

Pulmonary embolism
COPD
Heart failure

Cough:

COPD
Heart failure
Malignancy
GORD
Bronchiectasis

Question 5

Aetiology

Answer 5

Chronic inflammatory condition of the airways secondary to allergic and airway hyper-responsiveness.

This leads to bronchospasm and excessive secretions.

Obstructive pattern.

There are many precipitating factors that can result in an acute attack.