ASTHMA

Question 1

Asthma

Answer 1

• REVERSIBLE obstruction of the airways
• It is a chronic inflammatory disease
• Associated with a FHx asthma

Question 2

Asthma symptoms

Answer 2

Due to bronchoconstriction (constriction of airways)
- Cough
- Wheezing
- Chest tightness
- SOB

Question 3

Diagnosis

Answer 3

1. Presence of asthma symptoms
2. FHx
3. Reversibility test using spirometer
4. PEF
5. FeNO
6. Blood tests - inflammatory markers

Question 4

Order of diagnosis test for age 17 and over

Answer 4

1. FeNO
2. Spirometry
3. BDR if spirometry shows obstruction
4. if uncertainty remains = peak flow

Question 5

Order of diagnosis test for age 5 to 15

Answer 5

1. Spirometry
2. Consider BDR if spirometry shows obstruction
3. If child is unable to perform objective tests = observation and clinical judgement

Question 6

Reversibility test using a spirometer

Answer 6

• 5+
• FEV1/FVC ratio less than 70% suggests asthma

Question 7

PEF

Answer 7

• Patient blows through a peak flow meter
• They do that over 2-4 weeks and keep a diary

Question 8

FeNO

Answer 8

• 17+
• Confirms eosinophilic airway inflammation
• NO levels increased in the breath of asthmatics
• If it is high >35 ppb = +

Question 9

Testing blood for inflammatory markers

Answer 9

e.g. Eosiniphils and IgE

Question 10

How do you diagnose
Asthma in children under 5 years?

Answer 10

• Can’t use reverse spirometry
• Clinical observation and judgement

Question 11

Aims of treatment for asthma

Answer 11

• No daytime symptoms
• No night-time awakening due to asthma,
• No asthma attacks
• No need for rescue medication
• No limitations on activity including exercise
• Normal lung function (FEV, and/or PEF > 80% predicted or best)
• Minimal side-effects from treatment

Question 12

What are the lifestyle changes for asthma?

Answer 12

• Weight loss in overweight patients may lead to an improvement in asthma symptoms
• Stop smoking
• Breathing exercise programmes

Question 13

Types of asthma

Answer 13

1. Acute (asthma attack)
2. Chronic

Question 14

What age is considered an “Adult” for the management of asthma?

Answer 14

NICE
- 17 years old AND over

Question 15

Age categories

Answer 15

1. Adult
   - NICE: 17yrs and over
   - BTS: >12yrs
2. Child
   - 5 years and over
3. Child < 5yr

Question 16

When do you step down patients from the asthma treatment ladder?

Answer 16

• If the patient has been controlled on their current maintenance therapy for at least three months

Question 17

How do you decrease
ICS dose?

Answer 17

• The patient should try to reduce their ICS dose by 25-50% when told so by their prescriber
• Only consider stopping ICS if the patient is either on very-low dose or Low dose (adult) ICS and is symptom-free

Question 18

What vaccine should asthmatics get per year?

Answer 18

Flu