Asthma

Question 1

Define Asthma

Answer 1

Common chronic inflammatory condition of the airway which is reversible

Question 2

Common characteristics of asthma

Answer 2

1. Reversible airflow limitation
2. Airway hyper-responsiveness
3. Bronchial inflammation

Question 3

What are the changes to the airway in chronic asthma?

Answer 3

Irreversible airflow limitation as a result of airway remodelling and mucus impaction

Question 4

Prevalence

Answer 4

Increasing globally
More common in the west
Affects around 5-8% of the population

Question 5

Classification of asthma

Answer 5

Extrinsic (allergic)

Intrinsic (non allergic)

Question 6

Causes and triggers of Asthma

Answer 6

1. Allergens
2. Occupational sensitisers
3. Viral
4. Atmospheric pollution
5. Emotion
6. Drugs i.e. NSAIDs, B-Blockers
7. Cold air

Question 7

Why are NSAIDs contraindicated in asthma?

Answer 7

NSAIDs inhibit the COX-1 pathway which further prevents the production of anti-inflammatory prostaglandins. This results in the overproduction of pro-inflammatory leukotrienes to causes severe exacerbations of asthma

Question 8

Why are Beta blockers contraindicated in asthma?

Answer 8

Airways have a direct parasympathetic innervation

No direct sympathetic innervation on airways

Question 9

Clinical symptoms of Asthma

Answer 9

Wheeze
SOB
Diurnal variation
Cough

Question 10

Key questions to ask when taking an asthma history

Answer 10

1. Precipitants
2. Diurnal variation
3. Exercise tolerance
4. Home enviroment
5. Acid reflux

Question 11

Clinical signs of Asthma

Answer 11

Tachypnoea
Audible wheeze
Hyperinflated chest
Hyperresonant percussion
Inability to complete sentences

Question 12

Clinical tests

Answer 12

PEFR
FBC
U+E
Spiro
CRP
ABG
Sputum culture

Question 13

Asthma differentials

Answer 13

Pulmonary oedema
COPD
Large airway obstruction
SVC obstruction
PE
Pneumothorax

Question 14

Main aims of treatment

Answer 14

Abolish symptoms
Restore normal/best possible lung function
Reduce risk of severe attacks
Enable normal growth of children

Question 15

Step 1 of management

Answer 15

Occasional symptoms

Manage with SABA (i.e. Salbutamol)

Question 16

When do you escalate to step 2?

Answer 16

If the SABA is used more than once daily

Question 17

Step 2 of management

Answer 17

SABA + ICS (i.e. beclemtasone)

Question 18

When do you escelate to step 3?

Answer 18

If condition is still uncontrolled

Question 19

Step 3 of management

Answer 19

ICS + LABA (i.e. salmeterol)

Increase ICS if still symptomatic

Stop LABA if no effect

Question 20

Step 4 of management

Answer 20

Consider max dose of ICS + modified release theophyline + modified release B2 agonist

Question 21

Step 5 of management

Answer 21

Oral prednisolone + step 4 + Refer

Question 22

Summarise stepwise management

Answer 22

1. SABA
2. SABA + ICS standard dose
3. LABA + ICS
4. LTRA + max dose ICS + oral theophylline
5. Refer + oral pred + step 4