Asthma

Question 1

What is the atopic triad?

Answer 1

Asthma, allergic rhinitis and atopic eczema

Question 2

What type of hypersensitivity reaction is asthma?

Answer 2

Type 1

Question 3

What are the symptoms of asthma?

Answer 3

• Wheeze
• Dyspnoea
• Cough (can be nocturnal)
• Chest tightness
• Diurnal variation

Question 4

What are the signs of asthma?

Answer 4

Tachypnoea
hyperinflated chest
Hyper-resonace on percussion
Decreased air entry
Wheeze on auscultation

Question 5

What are signs of a severe asthma attack?

Answer 5

• Inability to speak in complete sentences,
• Respiratory rate >25
• Peak flow 30-50% of predicted
• Pulse > 110

Question 6

What are signs of a life threatening asthma attack?

Answer 6

• Silent chest
• Confusion
• Bradycardia
• Cyanosis
• Exhaustion
• O2 sats below 92%

Question 7

What are the investigations for chronic asthma?

Answer 7

• Peak flow diary which will show 20% variability
• Fractional exhaled nitric oxide (>40 ppb in adults and >35 in children)
• Spirometry: FEV1/FVC ration < 0.7

Question 8

What are the important investigations in an acute asthma attack?

Answer 8

• ABG (Type 2 resp failure is a sign of life-threatening asthma)
• Routine blood tests to look for precipitating cause eg, infection
• Chest x ray to exclude differentials

Question 9

What are signs of a moderate asthma attack?

Answer 9

PERF (peak flow) 50-75% of normal/predicted
Speech normal
RR <25
Pulse <110

Question 10

Explain the management of an acute asthma attack

Answer 10

-1. Ensure patent airway and give oxygen
2. Nebulised salbutamol
3. Oral prednisolone or IV hydrocortisone (if severe)
4. Nebulised ipratropium bromide
5. IV magnesium sulphate if severe
6. IV aminophylline if severe

Question 11

What is the management of chronic asthma

Answer 11

1. Short-acting B2 agonist
2. Add low-dose ICS (less than 400micrograms of budesonide)
3. Add oral leukotriene receptor antagonist (montelukast)
4. Add a Long-acting B2 agonist (salmeterol)
5. Increase ICS

Question 12

What are some asthma mimics?

Answer 12

• Acid-reflux
• Eosinophilic granulomatosis with polyangiitis
• Allergic bronchopulmonary aspergillosis