ASTHMA

Question 1

How is asthma clinically defined in terms of airway characteristics?

Answer 1

It is a chronic respiratory disease characterized by reversible airways inflammation and hyper-responsiveness.

Question 2

During the early phase of an asthma response, which antibody type activates mast cells upon exposure to stimuli?

Answer 2

IgE response.

Question 3

Which three primary mediators are released by mast cells during the early phase of an asthma attack?

Answer 3

Leukotrienes, cytokines, and histamine.

Question 4

What are the two physiological results of mediator release during the early phase of asthma?

Answer 4

Smooth muscle (SM) constriction and inflammation.

Question 5

Which three cell types are recruited during the late phase of the asthma inflammatory response?

Answer 5

T cells, macrophages, and eosinophils.

Question 6

Asthma-related coughing typically occurs during which two times of day?

Answer 6

Nocturnal (nighttime) or early morning.

Question 7

List four common symptoms of asthma used during clinical assessment.

Answer 7

Coughing, shortness of breath (SOB), chest tightness, and wheezing.

Question 8

Which cardiac and respiratory conditions must be ruled out when diagnosing asthma?

Answer 8

Heart failure (HF), angina, COPD, and bronchiectasis.

Question 9

Which two non-respiratory conditions should be excluded during an asthma differential diagnosis?

Answer 9

Anemias and anxiety.

Question 10

By what mechanism do NSAIDs trigger bronchoconstriction in sensitive asthma patients?

Answer 10

Inhibition of the COX enzyme.

Question 11

Why are Beta Blockers contraindicated in patients with severe asthma?

Answer 11

They can cause bronchoconstriction and trigger severe asthma attacks.

Question 12

What are the two first-line diagnostic tests for chronic asthma in patients over 16 years old?

Answer 12

Eosinophil count and FeNO (Fractional exhaled Nitric Oxide).

Question 13

What FeNO level is considered positive for asthma in patients aged 16 and older?

Answer 13

50 ppb or higher.

Question 14

In spirometry for patients over 16, what increase in FEV1 (percentage and volume) indicates reversibility?

Answer 14

An increase of 12% or more AND an increase of at least 200mL.

Question 15

What percentage of Peak Expiratory Flow (PEF) variability is required to confirm an asthma diagnosis?

Answer 15

Variability over 20%

Question 16

What is the first-line objective test for chronic asthma in children aged $5$ to $16$?

Answer 16

FeNO (Fractional exhaled Nitric Oxide).

Question 17

What FeNO level is considered positive for asthma in children aged $5$ to $16$?

Answer 17

$35$ ppb or higher.

Question 18

How is chronic asthma diagnosed in children under $5$ years of age?

Answer 18

Diagnosis is based on clinical judgement and regular review.

Question 19

What is the normal reference range for Eosinophils in a microL of blood?

Answer 19

0-300 cells/muL

Question 20

High Eosinophil counts in asthma patients are a potential marker for responsiveness to which class of medication?

Answer 20

Steroids.

Question 21

What does a FeNO test specifically measure in the patient’s breath?

Answer 21

Nitric oxide.

Question 22

What $FEV_{1}/FVC$ ratio value is used to confirm obstructive lung diseases like asthma or COPD?

Answer 22

A ratio under $0.7$.

Question 23

Describe the process for measuring reversibility during a spirometry test.

Answer 23

Perform 3 breaths, administer 2 puffs of a rapid-acting bronchodilator (e.g., salbutamol), then repeat the breaths.

Question 24

How frequently should Peak Expiratory Flow (PEF) readings be taken to calculate variability for diagnosis?

Answer 24

$3$ readings twice a day over a period of $2$ weeks.

Question 25

Concept: SABA

Answer 25

Definition: Short-acting beta agonist (e.g., Salbutamol) used mainly for quick relief of symptoms.

Question 26

Which LABA is unique because it can be used as a reliever due to its rapid onset of action?

Answer 26

Formoterol.

Question 27

What is the typical duration of action for Long-acting beta agonists (LABAs) like salmeterol?

Answer 27

$12$ hours.

Question 28

How many night-time wakings per week indicate poor asthma control?

Answer 28

$1$ night per week.

Question 29

A patient using a reliever more than _____ times per week is considered to have poor asthma control.

Answer 29

$3$ times per week.

Question 30

What is the maximum number of daily PRN puffs allowed for a patient using AIR therapy with Duoresp Spiromax?

Answer 30

$8$ puffs.

Question 31

What are the components of the combined inhaler Duoresp Spiromax?

Answer 31

Budesonide and Formoterol.

Question 32

For a patient on Low-dose MART therapy, what is the standard maintenance dosing schedule?

Answer 32

$1$ puff in the morning and $1$ puff at night.

Question 33

At what age is the Fostair ($100/6$ mcg) evohaler/NEXThaler licensed for use in MART therapy?

Answer 33

$18$ years and older.

Question 34

If a patient's symptoms are uncontrolled on MART but FeNO/Eosinophils are normal, what is the first-line LTRA to consider?

Answer 34

Montelukast ($10$ mg at night).

Question 35

What LAMA may be added to treatment if a patient remains uncontrolled on moderate-dose MART?

Answer 35

Tiotropium ($5$ mcg in the morning).

Question 36

What is the standard first-line treatment for a new asthma diagnosis in patients aged $12$ and over (previous guidelines style)?

Answer 36

Low-dose ICS twice daily (e.g., Clenil) and SABA (Salbutamol) PRN.

Question 37

What is the maximum recommended number of SABA prescriptions per year for a well-controlled patient?

Answer 37

$3$ prescriptions per year.

Question 38

What are two common systemic side effects of excessive SABA use?

Answer 38

Tremors and hypokalemia.

Question 39

Why is a pMDI without a dose counter potentially dangerous when empty?

Answer 39

It may still release propellant gas without delivering any actual drug.

Question 40

What is the minimum period an asthma patient should be stable before considering deprescribing therapy?

Answer 40

$8$-$12$ weeks.

Question 41

In what order should asthma medications be deprescribed?

Answer 41

In the order of the latest prescribed medication.

Question 42

How should a spacer device be cleaned?

Answer 42

With warm soapy water and air-dried (not wiped).

Question 43

How often should a spacer device be replaced?

Answer 43

Every $6$-$12$ months.

Question 44

Besides children, which patient group specifically benefits from using a spacer to prevent oral thrush?

Answer 44

Patients using Inhaled Corticosteroids (ICS).

Question 45

What are the three core physiological signs of acute asthma?

Answer 45

Tachycardia, tachypnoea, and reduced $O_{2}$ saturation.

Question 46

All patients following an acute asthma attack should receive GP follow-up within what timeframe?

Answer 46

$2$ days.

Question 47

What PEFR percentage and diurnal variation must be met for discharge/follow-up after an acute attack?

Answer 47

PEFR greater than $75\%$ and diurnal variation less than $20\%$.

Question 48

What is the initial salbutamol dosing regimen using a spacer for a moderate acute asthma attack?

Answer 48

$4$ doses initially, then $2$ doses every $2$ minutes (max of $10$).

Question 49

What is the standard prednisolone dose and duration for treating an acute asthma attack?

Answer 49

$40$ mg in a single dose for $5$ days.

Question 50

What are two common short-term side effects of a course of prednisolone?

Answer 50

GI disturbance and mood swings.

Question 51

How should a SABA be administered to a patient with severe or life-threatening asthma?

Answer 51

Via an oxygen nebulizer ($5$ mg every $20$-$30$ minutes).

Question 52

What IV medication is used for acute asthma if the patient is unable to swallow prednisolone?

Answer 52

IV hydrocortisone ($100$ mg $4$ times a day).

Question 53

If a severe asthma patient does not respond to salbutamol, which nebulized medication should be added?

Answer 53

Ipratropium ($0.5$ mg $3$-$4$ times a day).

Question 54

Which cell-derived mediators are primarily responsible for the triggers like pollen and animal fur causing symptoms?

Answer 54

Leukotrienes, cytokines, and histamine.

Question 55

Identify the inhaler type: Duoresp Spiromax.

Answer 55

Dry powder breath-actuated inhaler.

Question 56

Identify the inhaler type: Tiotropium (in the context of management options).

Answer 56

Soft mist.

Question 57

What is the specific budesonide/formoterol strength found in Duoresp Spiromax?

Answer 57

$160/4.5$ mcg.

Question 58

What are the two available strengths for Symbicort Turbohaler mentioned in the guidelines?

Answer 58

$100/6$ mcg and $200/6$ mcg.

Question 59

In pediatric management (ages $12$ and over), if Option 1 (MART) is not used, what is Option 2 for poor control?

Answer 59

Montelukast for $8$-$12$ weeks, followed by additional Low-dose LABA/ICS.

Question 60

What specific objective test determines bronchial hyper-responsiveness as a fourth-line diagnostic tool?

Answer 60

Bronchial hyper-responsiveness (Challenge test).

Question 61

For the PEF process, how long should the patient hold their breath before breathing out?

Answer 61

$2$ seconds.

Question 62

How many breaths are performed during a single spirometry step to ensure accuracy?

Answer 62

$3$ breaths (taking the best reading of the $3$).

Question 63

In the context of poor control, how many times per week must a patient be symptomatic to qualify?

Answer 63

$3$ times per week.

Question 64

When managing symptoms that remain uncontrolled on Moderate-dose MART, how long should you wait to assess the effectiveness of adding an LTRA or LAMA?

Answer 64

$3$ months.