Asthma

Question 1

What are the three key characteristics of asthma?

Answer 1

• Airflow limitation (usually reversible)
• Airway hyper‑responsiveness
• Airway remodelling

Question 2

What is the central driver of asthma pathogenesis?

Answer 2

Airway inflammation involving immune cells, airway epithelium, leukocytes, and structural cells

Question 3

What structural airway changes occur in asthma?

Answer 3

• Smooth muscle hyperreactivity
• Increased inflammation
• Excess mucus production
• Fibrosis and scarring
• Airway wall thickening → remodelling

Question 4

What triggers the early phase of an asthma attack?

Answer 4

IgE‑mediated mast cell activation in response to environmental allergens

Question 5

Which mediators are released during mast cell degranulation?

Answer 5

Histamine, prostaglandins, leukotrienes → smooth muscle contraction → bronchoconstriction

Question 6

Which cytokines are produced by Th2 cells in early‑phase asthma?

Answer 6

IL‑4, IL‑5, IL‑13, GM‑CSF

Question 7

What are the roles of IL‑3, IL‑5, and IL‑13 in asthma?

Answer 7

• IL‑3 & IL‑5: Eosinophil and basophil survival
• IL‑13: Airway remodelling, fibrosis, goblet cell hyperplasia

Question 8

What characterises the late phase of asthma?

Answer 8

Recruitment of eosinophils, basophils, neutrophils, Th cells → sustained inflammation + bronchoconstriction

Question 9

What is airway remodelling?

Answer 9

Chronic structural airway changes due to persistent inflammation → thickened walls, fibrosis, reduced flexibility

Question 10

What cellular processes drive airway remodelling?

Answer 10

• Epithelial–mesenchymal transition
• Goblet cell hyperplasia
• Angiogenesis
• Basement membrane thickening
• Eosinophil release of TGF‑β

Question 11

What genetic factors increase asthma risk?

Answer 11

Family history of atopy: asthma, allergic rhinitis, eczema

Question 12

What environmental factors contribute to asthma development?

Answer 12

Urbanisation, diet, stress, pollution, smoke exposure, viral infections, allergens

Question 13

List common asthma triggers

Answer 13

• Viral: RSV, rhinovirus
• Weather changes
• Aspirin
• Perfumes, sprays
• Smoke, dust mites, mould
• Animal dander

Question 14

What does NICE require for asthma diagnosis?

Answer 14

Suggestive clinical history + at least one positive objective test

Question 15

What symptoms support a clinical history of asthma?

Answer 15

Wheeze, cough, breathlessness, chest tightness, symptom variability, identifiable triggers, atopic history

Question 16

What does a FeNO test measure?

Answer 16

Nitric oxide in exhaled breath → marker of eosinophilic airway inflammation

Question 17

What FeNO values indicate inflammation in adults?

Answer 17

• > 40 ppb: High
• 25–40 ppb: Intermediate
• <25 ppb: Negative

Question 18

What is FEV1?

Answer 18

Forced expiratory volume in 1 second

Question 19

What is FVC?

Answer 19

Forced vital capacity — total exhaled volume after full inspiration

Question 20

What is the FEV1/FVC ratio used for?

Answer 20

Identifying obstructive lung disease

Question 21

What is a reversible FEV1 test?

Answer 21

FEV1 measured before and after bronchodilator → improvement indicates asthma

Question 22

What is a bronchial challenge test?

Answer 22

Methacholine exposure → measure FEV1 drop; >20% fall indicates hyper‑responsiveness

Question 23

What is the first‑line treatment for newly diagnosed asthma?

Answer 23

MART therapy: Low‑dose ICS + formoterol (maintenance and reliever)

Question 24

What defines difficult or therapy‑resistant asthma?

Answer 24

• Poor symptom control
• ≥2 severe exacerbations/year
• ≥1 hospitalisation
• FEV1 <80% predicted despite therapy
• Frequent oral steroid use

Question 25

How do SABAs work?

Answer 25

Bind β2 receptors → activate adenylate cyclase → ↑ cAMP → activate PKA → smooth muscle relaxation.

Question 26

Why are SABAs no longer first‑line?

Answer 26

Over‑reliance increases mortality; ICS‑formoterol preferred

Question 27

Why must LABAs never be used without ICS?

Answer 27

Increased risk of asthma‑related death

Question 28

Which LABA has rapid onset suitable for MART?

Answer 28

Formoterol

Question 29

How do inhaled corticosteroids work?

Answer 29

* Bind intracellular glucocorticoid receptors * Form GRE complexes * ↓ cytokines, ↓ COX‑2, ↑ lipocortin‑1 * Reduce inflammation

Question 30

How do leukotriene receptor antagonists work?

Answer 30

Block CysLT1 receptors → ↓ bronchoconstriction + ↓ mucus secretion

Question 31

How do muscarinic antagonists work?

Answer 31

Block M3 receptors → prevent vagal bronchoconstriction → bronchodilation

Question 32

Why is theophylline rarely used?

Answer 32

Narrow therapeutic index; requires plasma monitoring; many interactions

Question 33

What is mepolizumab?

Answer 33

Anti‑IL‑5 monoclonal antibody for severe eosinophilic asthma

Question 34

What are signs of a life‑threatening asthma attack?

Answer 34

* PEF <33% * O2 sats <92% * Altered consciousness * Cyanosis * Silent chest * Arrhythmia * Exhaustion

Question 35

What is first‑line treatment for severe/life‑threatening exacerbation?

Answer 35

* Oxygen (94–98%) * Nebulised SABA (5 mg) * Add nebulised ipratropium if poor response * Oral/IV steroids

Question 36

What is the inhaler‑spacer regimen if no nebuliser is available?

Answer 36

* 4 puffs initially * Then 2 puffs every 2 minutes * Max 10 puffs * Repeat every 10–20 minutes if needed

Question 37

What are common SABA (Short-Acting Beta-Agonist) side effects?

Answer 37

Tremor, palpitations, headache, hypokalaemia

Question 38

What are ICS (inhaled corticosteroids) side effects?

Answer 38

Oral thrush, hoarse voice, sore throat

Question 39

What are SAMA/LAMA (short-acting-muscarinic antagonists/long-acting-muscarinic antagonists) side effects?

Answer 39

* Can't see (blurred vision) * Can't pee (urinary retention) * Can't spit (dry mouth) * Can't sh*t (constipation)