Week 2 - Asthma In Adults

Question 1

When are symptoms usually worse?

Answer 1

Beginning or end of day

Question 2

What are 5 symptoms?

Answer 2

Chest tightness, cough, wheeze, SoB and difficulty in expiration

Question 3

What are the proven aetiological factors? (3)

Answer 3

• Hereditary (atopy)
• Maternal/grandmother smoking
• Occupational (bakers, planters, shellfish workers)

Question 4

What is Atopy? What influences it most?

Answer 4

Body’s predisposition to develop antibody IgE, and its hereditary. Linked to asthma, eczema and hay fever.

Maternal atopy is most influential

Question 5

What are the non-proven trends in aetiology of asthma?

Answer 5

Obesity, diet and ‘hygiene hypothesis’ as a child

Question 6

What history would you look out for in the initial clinical assessment? (6)

Answer 6

Symptoms, variation (how often and when), triggers, past medical history, family and social history, current asthma drugs

Question 7

What do finger clubbing or cervical lymphadenopathy suggest?

Answer 7

Not asthma but lung cancer

Question 8

What is stridor and what does it suggest?

Answer 8

Harsh wheeze on inspiration - foreign body/tumour obstructing airways

Question 9

What does an asymmetrical expansion or dull percussion chest sound suggest?

Answer 9

Pneumonia or collapsed lung

Question 10

What are 3 other causes of a general airflow obstruction?

Answer 10

COPD, cystic fibrosis or bronchiectasis

Question 11

What test should be done in suspicion of asthma?

Answer 11

Spirometry FEV1/FVC test

Question 12

If the FEV1/FVC ratio is below 70%, what further tests should follow?

Answer 12

• Full pulmonary function test to exclude COPD and emphysema
• CO gas transfer test
• Oral steroids for 2 weeks and see peak flow difference

Question 13

What does a CO gas transfer test tell us?

Answer 13

Measures affinity of CO to haemoglobin. In asthma this should be normal or increased. In COPD it should be decreased due to alveolar reduction. Can be used to differentiate between the 2

Question 14

How is the FEV1/FVC test carried out to test for asthma?

Answer 14

Check result before and 15 minutes after salbutamol administration. If spirometry increases, most likely astma

Question 15

If spirometry is normal, what further tests do we carry out for asthma?

Answer 15

• Check for >20% variability in peak flow, 3X a day for 2 weeks
• Patient inhales various chemicals, and test if airway reactivity increases causing FEV1 to drop
• high Exhaled NO levels - airway inflammation

Question 16

What does moderate asthma look like?

Answer 16

Can speak, HR below 110, Resp. Rate below 25, peak flow 50-75%, O2 saturation 92% and above, PaO2 8kPa or above, low PaCO2 (exhaling a lot)

Question 17

What do we look for to determine grade of asthma? (7)

Answer 17

Speech, HR, RR, O2 saturation, peak flow, PaO2, PaCO2

Question 18

What are the 4 grades of asthma?

Answer 18

Moderate, severe, life threatening or near fatal

Question 19

What does severe asthma look like?

Answer 19

Anything opposite to moderate asthma
HR >120, RR >30, and peak flow 33%-50% low

Question 20

What does life threatening asthma look like?

Answer 20

Grunting, impaired consciousness, exhaustion or confusion. Peak flow below 30%. Cyanosis, silent chest, paCO2 is normal - not exhaling well

Question 21

What does near fatal asthma look like?

Answer 21

PaCO2 is high, needs manual ventilation

Question 22

What inhaled therapies are available for asthma?

Answer 22

Preventation - MDI (metre dose inhalers) and DPI (dry powder inhalers)
Relieving flares - SABA - salbutamol by MDI or DPI

Question 23

What oral therapies are available for asthma? (3)

Answer 23

LTRA - leukotrine receptor antagonist
Theophylline (bronchodilators) - difficult asthma
Prednisolone - long term, not ideal

Question 24

What specialist option therapies are available for some asthma patients?

Answer 24

Omalizumab (anti IgE) and Mepolizumab (anti IL-5) target pathological process of asthma development. May help patients come off oral steroids

Question 25

When would IV be used for asthma treatment? What’s a negative?

Answer 25

In hospital for faster delivery, hydrocortisone should be used to decrease inflammation

Hydrocortisone IV is shorter acting so need it 3X a day, rather than once a day for prednisolone

Question 26

What is level 1, 2 and 3 care?

Answer 26

1 is clinic based
2 is single organ support
3 is high intensity care