Asthma

Question 1

Definition

Answer 1

Chronic inflammatory disease of airways where many cells and play role, in particular mast, neutrophils, eosinophils, T cells, macrophages, epithelia.
Causes recurrent cough (especially at night), wheeze, SOB, chest tightness due to widespread variable reversible airflow obstruction.

Question 2

Aetiology

Answer 2

Genetic predisposition likely.
Allergic/extrinsic triggered by exposures causing IgE response.
Non allergic intrinsic in response to infection or stress.
Occupational exposure or exercise or drug induced.
Inflammatory condition fo bronchial hyper responsiveness. Inflammation (thickening), bronchsopasm and excessive secretion.
TH2 phenotype.
Reversible.

Question 3

Differentials

Answer 3

Pulmonary oedema
Pulmonary fibrosis
COPD
FB
Malignancy
Pneumothorax
Brochiectasis or bronchitis
Rhinitis
GORD
Pneumonia
Anxiety
Diffuse ILD
Hypersensitivity pneumonitis
CHF
PE

Question 4

Management

Answer 4

Lifestyle-
Avoid triggers, stop smoking, hygiene eg dust.
Drugs-
SABA. Education on inhaler use.
Then add low dose inhaled CS eg beclomethasone if SABA used more than 3x a week or waking 1x a week. Steroid inhibits transcription in inflammatory cells and mediators, decrease eosinophils and mast, increase beta 2 R expression and anti inflammatory IL’s.
Then go to medium dose ICS
Then go to LABA eg salemterol.
Then high dose ICS, can add eg leukotriene R antagonist.
Then oral CS eg prednisolone.
ADRs-
Beta agonist eg tachy, palpitation, tremor, anxiety, HYOKALAEMIA.
ICS eg croaky voice, sore throat, thrush.

Question 5

Symptoms

Answer 5

Dyspnoea
Wheeze
Nocturnal cough- exercise induced in day, dry
Sputum
Tight chest

Question 6

Signs

Answer 6

Tachypnoea and tachycardia
Accessory muscles, tracheal tug, intercostal recession, nasal flaring. 
Prolonged expiratory phase
Wheeze
Hyperinflated chest
Hyper resonance
Decreased air entry
Pectus excavatum

Question 7

Complications

Answer 7

Pneumonia
Pneumothorax
Respiratory failure and arrest
Status asthmaticus not respond to immediate treatment.

Question 8

Diagnosis

Answer 8

Peak flow vs predicted, diary, diurnal variation

Spirometry obstructive pattern- FEV1/FVC under 70%

Question 9

In the history

Answer 9

PNH- eczema, hayfever
FH- atopy, smoking
SH- mound, farm, wood burning fire, pets
DH- any drugs make it worse eg NSAIDs

Question 10

Acute attack grading
Mild to moderate T1 respiratory failure
Severe T2

Answer 10

• mild- sats over 92, pulse under 110, RR under 25, speech fine, minimal wheeze, PEFR over 75% of predicted.
• moderate- same but more of a wheeze and PEFR 50-75% predicted.
• severe- sats under 92, pulse over 110, RR over 25, can complete sentence, no wheeze, PEFR 35-50%.
• life threatening- sats under 92 and cyanosis, silent chest, altered conciousness, exhaustion, PERF 35%.
• tx- SABA and ipratropium nebs, O2, IV access, ITU and intubation.

Question 11

Explanation

Answer 11

• Asthma is where your immune system over reacts to a trigger and causes an inflammatory reaction in your airways. Walls of the airways get thicker and tighter, and more mucous is produced, making it hard to breathe.
• rare complications and severe attacks. Ususally can be well amanged by avoiding triggers. Thinking about home environement.
• inhaler for when you get an attack to relax the airways. Then maybe a steroid inhaler for everyday to prevent the inflammatory response. Other options if that doesnt work. Can step down as well as up.