Asthma

Question 1

What causes airflow constriction seen in asthma?

Answer 1

• Bronchoconstriction
• Bronchial secretions and plugs of mucus
• Oedema of the bronchial wall

Question 2

What is ATOPY ?

Answer 2

• the genetic tendency to develop allergic disease
• tendency to form IgE antibodies to allergens
• often associated with hay fever or eczema in the personal or family history

Question 3

What are the symptoms of asthma?

Answer 3

• cough
• wheeze
• breathlessness
• chest tightness
  occurs in episodes
• Diurnal variability; day or night?

Question 4

What are constriction triggering factors?

Answer 4

• Change in temp.
• Exercise
• strong odours
• cold air
• emotion and stress

Question 5

What are inflammation triggering factors?

Answer 5

• Respiratory infections
• Allergens
• Work place

Question 6

What medications can be triggering for Asthma?

Answer 6

• Aspirin
• Ibuprofen
• Beta blockers

Question 7

What investigations can be done for Asthma?

Answer 7

• Peak flow 2x a day
• spirometry: airflow obstruction may be normal between attacks
• CXR: hyperinflation
• increased eosinophil count
• Fraction exhaled nitric oxide

Question 8

What are the test lung function results that would indicate Asthma

Answer 8

• FEV1/FVC <70
• PEFR monitoring - 20% diurnal variation
• is it reversible with bronchodilators e.g salbutamol
• 15% and 200mls improvement in FEV1 from baseline

Question 9

What is FeNO-Fraction of exhaled NO and when is it used?

Answer 9

• measure of airway of eosinophilic inflammation
• performed on patients not on any treatment
• a positive test >40ppb supports a diagnosis of asthma
• can be used to monitor/ look at compliance

Question 10

What are non-pharmacological treatment of asthma?

Answer 10

• smoking cessation
• weight reduction
• being in less polluted areas

Question 11

What are long term inhaled pharmacological managements of asthma?

Answer 11

Inhaled corticosteroids
- beclometasone, fluticasone, budesonide, ciclesonide
Inhaled long acting beta 2 agonists (LABA)
- in combination with ICS if its still symptomatic
- never by itself

Question 12

What are long term oral pharmacological managements of asthma?

Answer 12

• oral leukotriene antagonist-montelukast
• oral theophyllines
  in patients with chronicall poorly controlled asthma: low dose of long term oral steroids: prednisolone

Question 13

What are short term inhaled pharmacological managements of asthma?

Answer 13

Short acting beta agonists (SABA)
- Salbutamol
- Terbutaline
taken as an inhaler 100mcg or nebuliser (high dose 2.5mg, driven by oxygen)

Question 14

What is Maintenance and Reliever Therapy (MART)?

Answer 14

• LABA formoterol has short onset action
• Equivakent od salbutamal (SABA)
• certain ICS/ LABA combinations can be used as relievers as well as preventers
• this means patients can take additional doses (4/day) for short pperiod (2-3) days to rapidly treay any worsening asthma symptoms

Question 15

What are DPIs and pMDIs?

Answer 15

Dry power inhalers: activated by inspiration by the patient.–> Powdered drug is dispersed into particles. More mistakes

Pressurised metered dose inhalers: drug dissolved in a propellent (HFCs) under a pressure valve system which releases a metered dose

Question 16

What very speciliased treatment can be given to a small number of patients with difficult asthma?

Answer 16

• Monoclonal antibody
  
  • anti-IgE injections (omalizumab)
  • anti IL-5 treatment (mepolizumab)
• Bronchial thermoplasty

Question 17

What is a Personal Asthma Action Plan (PAAP)?

Answer 17

A clear plan for patients to see what medication they should be taken and how they should be taking it.

Also explains symptoms they should be looking for in their own asthma and what medication to take

• improves asthma control
• reduces emergency contact with GP
• reduces hospital admissions

Question 18

What are general features of Acute Severe Asthma?

Answer 18

• Peak expiratory flow rate (PEFR) 33-50% of best (use % predicted if recent best unknown)
• Can’t complete sentences in one breath
• Respirations ≥25 breaths/min
• Pulse ≥110 beats/min

Question 19

What are life threatening features of Acute Severe Asthma?

Answer 19

• PEFR <33% of best or predicted
• SpO2 (oxygen sat.) <92% (regardless of air or oxygen)
• Silent chest, cyanosis, or feeble respiratory effort
• Arrhythmia or hypotension
• Exhaustion, altered consciousness

Question 20

What is the management for severe acute asthma?

Answer 20

• Oxygen
• Corticosteroids: prednisolone 40-60mgs orally
• Beta-2 Bronchodilator, through a nebuliser (oxygen driven) - Salbutamol or through a spacer