Asthma

Question 1

What is asthma?

Answer 1

A chronic inflammatory disorder of the airways characterized by episodic reversible airway obstruction, increased bronchial reactivity, and airway inflammation.

Question 2

What is the prevalence of asthma in Nigerian children?

Answer 2

Physician-diagnosed asthma: 2.5% overall; 3.1% in 6–17-year-olds; highest in Lagos (8%).

Question 3

At what age is asthma most common?

Answer 3

Most common under 5 years; 50% present by age 3; many transient wheezers stop by 6 years.

Question 4

What is the gender pattern of asthma?

Answer 4

Prepubertal: M>F; Adolescence: M=F; Adulthood: F>M.

Question 5

What are major risk factors for childhood asthma?

Answer 5

Family history of allergy/asthma, high IgE levels, viral infections, aeroallergens, cigarette smoke, fumes, obesity, and low socioeconomic status.

Question 6

What hypothesis explains asthma development?

Answer 6

Hygiene hypothesis — imbalance between Th1 and Th2 cytokines leading to IgE production to environmental allergens.

Question 7

What inflammatory cells are involved in asthma?

Answer 7

Mast cells, eosinophils, T-lymphocytes, macrophages, dendritic cells, and neutrophils.

Question 8

What are the main pathophysiologic processes in asthma?

Answer 8

Airway inflammation, bronchospasm, mucus plugging, mucosal edema, airway obstruction, hyperinflation, and V/Q mismatch.

Question 9

What are key symptoms of childhood asthma?

Answer 9

Recurrent cough (often nocturnal), breathlessness, wheezing, chest tightness.

Question 10

What factors commonly precipitate asthma attacks?

Answer 10

Viral infections, allergens, smoke, exercise, emotions, drugs (aspirin, beta-blockers), foods, menses.

Question 11

What is important in family and social history for asthma?

Answer 11

Family history of asthma/allergy; history of hospitalizations or frequent exacerbations.

Question 12

What are common findings on physical exam during an acute asthma attack?

Answer 12

Tachypnea, dyspnea, expiratory rhonchi (± inspiratory), pulsus paradoxus, chest hyperinflation.

Question 13

What is seen in severe asthma?

Answer 13

Breathless at rest, can’t talk/feed, agitated, sitting upright, SpO₂ <92%, PEFR <50% predicted.

Question 14

What are signs of life-threatening asthma?

Answer 14

Silent chest, cyanosis, confusion, exhaustion, hypotension, poor respiratory effort.

Question 15

What are the categories of asthma severity?

Answer 15

Intermittent: ≤1/week, <2 nocturnal/month. Mild persistent: >1/week but <1/day. Moderate persistent: daily. Severe persistent: continuous.

Question 16

What are key investigations for asthma?

Answer 16

FBC (eosinophilia), IgE levels, CXR (hyperinflation), spirometry (reversible obstruction), peak flow monitoring, allergy testing.

Question 17

What spirometry pattern indicates obstruction?

Answer 17

Normal FVC, reduced FEV₁, reduced FEF25–75%. Reversibility after bronchodilator confirms asthma.

Question 18

What are the four keys of asthma therapy?

Answer 18

1) Assessment & monitoring, 2) Education, 3) Control of environmental/comorbid factors, 4) Medications.

Question 19

How often should spirometry be done?

Answer 19

Every 1–2 years, or more frequently if uncontrolled.

Question 20

What are components of patient education?

Answer 20

Environmental control, peak flow/symptom monitoring, correct inhaler technique, adherence.

Question 21

What are the rapid-relief (rescue) medications for asthma?

Answer 21

Short-acting bronchodilators (salbutamol), systemic corticosteroids, ipratropium bromide.

Question 22

What are control (maintenance) medications?

Answer 22

Inhaled corticosteroids, long-acting bronchodilators, theophylline, leukotriene modifiers, cromolyn, anti-IgE (omalizumab).

Question 23

What is Seretide?

Answer 23

Combination of fluticasone (steroid) + salmeterol (long-acting bronchodilator).

Question 24

What is the first-line treatment in an acute asthma attack?

Answer 24

Oxygen therapy, nebulized salbutamol every 20 mins for 1 hour, IV hydrocortisone, oral prednisolone, treat underlying infection.

Question 25

What drugs are used in severe or status asthmaticus?

Answer 25

IV aminophylline, magnesium sulphate, ipratropium bromide, adrenaline (if anaphylaxis).

Question 26

What medications are contraindicated in asthma attacks?

Answer 26

Sedatives — can cause respiratory arrest and are associated with avoidable deaths.

Question 27

When should a child with asthma be transferred to ICU?

Answer 27

If there is respiratory failure, need for intubation, or mechanical ventilation.

Question 28

What are discharge criteria after an acute attack?

Answer 28

Post-treatment lung function ≥40–60% predicted, or >60% if follow-up unavailable.

Question 29

What medications are prescribed on discharge?

Answer 29

Short course oral steroid (3–5 days), β₂ agonist as needed, inhaled corticosteroid ± LABA.

Question 30

What should be reviewed at discharge?

Answer 30

Inhaler technique, peak flow monitoring, trigger avoidance, written action plan, counseling.