Asthma

Question 1

What 3 things can cause asthma?

Answer 1

1. Chronic airway inflammation
2. Airway hyper-responsiveness
3. Increased mucus production

Question 2

What are some examples of environmental & immunological factors that can cause asthma?

Answer 2

Environment: allergy, IgE mediated inflammation from mast cells
Immunology: exposure to allergens, pollution.

Question 3

What are some examples of asthma presentations?

Answer 3

1. Hyperinflation of lungs
2. Could be asymptomatic
3. Silent chest (life threatening)

Question 4

What are the types of tests you can do to diagnose asthma?

Answer 4

1. Bloods: increased eosinophil count
2. CXR: chest x-ray for hyperinflation
3. Peak flow diary
4. FeNO test: measuring NO breath levels, a sign of inflammation
5. Spirometry

Question 5

What does spirometry measure and what is the expected result of an asthmatic?

Answer 5

It measures the vol. of air inhaled & exhaled.
FEV1/FVC <70% = asthmatic
This ratio can be measured before & after a bronchodilator is given to see if it helps.

Question 6

What is the skin prick test & what is measured from it?

Answer 6

Allergen is injected into the skin.
Mast cell degranulation present = histamine release = wheal & flare reaction on skin.
If wheal & flare is >3mm = significant reaction

Question 7

What are the steps taken if someones asthma is getting progressively worse, from a pharmacological point of view?

Answer 7

SABA –> low dose ICS –> +LABA –> increase ICS dose OR + LTRA (montelukast) –> REFER

SABA should be used throughout the whole treatment

Question 8

What does an asthma action plan contain?

Answer 8

1. What to do in poor control/emergency
2. Allows self adjustment in deteriorating events
3. Personalise a plan to take medication

Question 9

What can occur during an asthma review?

Answer 9

1. Review peak flow diary
2. Check spirometry
3. Review inhaler technique
4. Increase therapy if control is poor
5. Aim to decrease ICS dose if asthma is stable to avoid side effects

Question 10

What are the 3 severities of asthma?

Answer 10

1. Moderate
   - Peak expiratory flow (PEF) 0.5-0.7
2. Severe
   - Tachycardia
   - Increased HR/RR
   - PEF 0.3-0.5
3. Life threatening
   - Cyanosis
   - pO2 <92%
   - PEF <0.3
   - Silent chest

Question 11

What are possible managements of asthma, excluding bronchodilators?

Answer 11

1. O2 face masks
2. Steroids - prednisolone 40mg, or IV hydrocortisone 200mg
3. Mg sulphate
4. IV aminophylline

Question 12

When should you refer an asthmatic patient?

Answer 12

1. If their CO2 levels are increasing
2. If their PEF is decreasing even after treatment
3. Increased hypoxia & pH