Asthma

Question 1

Two types of asthma

Answer 1

1. Atopic (extrinsic)

2. Non-atopic (intrinsic)

Question 2

Risk factors for asthma (5)

Answer 2

1. Atopy (eczema, hay fever)
2. Family history
3. Smoking
4. Environmental exposures (air pollution, formaldehyde, dust mites, cockroaches, animal dander, mould)
5. Hygiene hypothesis

Question 3

Common asthma triggers (5)

Answer 3

1. Allergies (pollen, dust, pet dander, etc)
2. Viral infections
3. Cold air
4. Stress
5. Medications (beta blockers, aspirin, NSAIDs, ACE inhibitors)

Question 4

Symptoms of asthma (4)

Answer 4

1. Wheeze
2. SOB
3. Chest tightness
4. Cough - may produce purulent sputum (eosinophils)

Symptoms are usually worse at night/early morning or in response to exercise or cold air

Question 5

Investigations for asthma

Answer 5

1. Spirometry
   - FEV1 12% and >200mL bronchodilator response in FEV1 or FVC
   - Mannitol/methacholine challenge
2. Peak expiratory flow rates
   - >20% variability 3/7 days
   - >20% increase with bronchodilator
   - >20% decrease with trigger exposure

Question 6

Diagnostic framework for asthma

Answer 6

Shortness of breath plus ONE of:

1. Diurnal variability
2. Reversibility
3. Inducibility

Question 7

Management of asthma

Answer 7

1. SABA
2. Add low dose ICS
3. Add LABA combined with ICS
4. Increase dosages
5. Oral corticosteroids
6. Tiotropium bromide

Others: leukotriene antagonists