Asthma

Question 1

What are the triggers?

Answer 1

• Airway infections
• Allergy particles - house dust mite, pollen, fur
• Chemical irritants
• Air pollution
• Cold air
• Exercise
• Emotion e.g. stress
• Smoking
• NSAIDs
• Beta blockers

Question 2

Symptoms of an attack

Answer 2

• Wheezing
• SOB
• Chest tightness
• Nighttime or early morning coughing
• Night symptoms is a sign of poorly controlled asthma

Question 3

Differentials of bruising

Answer 3

1. Steroid use (unlikely with inhalers)
2. Depression with self-harm behaviour (look for superficial lacerations)
3. Domestic violence
4. Sports related trauma

Question 4

Changes in pregnancy

Answer 4

• Stuffy or runny nose and nosebleeds
• Chest becomes barrel-shaped or increases in size
• Upward movement of diaphragm
• Increase in amount of air breathed in and out
• Reduced lung capacity
• Increased oxygen use

Question 5

Drugs used as normal in pregnancy

Answer 5

• SABA
• LABA
• Inhaled corticosteroids
• Oral and IV theophylline

Question 6

Anaesthesia, asthma and pregnancy

Answer 6

Regional blockade is preferable to general due to potential risk of bronchospasm with certain inhaled anaesthetic patients.

Question 7

Physiological changes in asthma

Answer 7

Histamines and leukotrienes cause:

• Bronchoconstriction
• Increased vascular permeability and inflammation stimulating mucus production
• Inflamed mucosa

Question 8

Symptoms of asthma

Answer 8

• Cough
• Dyspnoea
• Tightness of chest
• Difficulty speaking
• Sputum from productive cough - curschman spirals (epithelium and mucus plug), charcot-leydin crystals (broken down eosinophils)

Question 9

What are signs of asthma exacerbation?

Answer 9

• Hyperresonance
• Wheezing upon expiration
• Accessory muscle use

Question 10

Signs of moderate acute asthma attack

Answer 10

• increased symptoms
• PEF >50-75% best or predicted
• no features of acute severe asthma

Question 11

Signs of acute severe asthma attack

Answer 11

• PEF 33-50% best or predicted
• RR > 25/min
• HR > 110bpm
• inability to complete full sentences

Question 12

Signs of life-threatening asthma attack

Answer 12

• PEF <33% best or predicted
• SpO2 <92%
• PaO2 < 8kPa
• Normal PaCO2 (patient tiring so not breathing out as much CO2)
• Altered conscious level
• Exhaustion - poor respiratory effort
• Arrhythmia
• hypotension
• cyanosis
• silent chest/less wheeze

Question 13

Signs of near-fatal asthma

Answer 13

Raised pCO2 and/or requiring mechanical ventilation with raised inflation pressures