Asthma - Clinical Features

Question 1

What are the key principles of asthma?

Answer 1

• No definition
• No tests
• 2 national guidelines for management
• Symptom based
• Acute attack identical to LRTI symptoms
• Relapse and remission pattern

Question 2

What are the key principles of asthma management?

Answer 2

• No wheeze, no asthma
• Tests may help decision
• If
  
  • QoL affected – give trial of ICS to confirm diagnosis
  • QoL not affected – watch and see

Question 3

What are the key words to describe what asthma is?

Answer 3

• Wheeze
• Variability
• Respond to treatment

Question 4

Asthma - pathology

Answer 4

• Chronic condition where airways constrict sporadically due to hypersensitity
• Is a syndrome basically

Question 5

Asthma - aetiology

Answer 5

• Genes (genetic predisposition)
  
  • 10 genetic variants making modest contribution – ADAM33, ORMDL3 (not everyone with these genes have asthma)
• Allergen exposure
• Smoke exposure
• Triggers

Question 6

What are some of the variations in asthma between different people?

Answer 6

• Transient vs persistent
• Different severities
• Different age of onset
• Different triggers

Question 7

Describe different possible kinds of asthma syndromes between different people?

Answer 7

Question 8

Asthma - epidemiology

Answer 8

• Common condition (5% children on inhaled steroids)

Question 9

Asthma - investigations

Answer 9

• Perform spirometry before and after giving bronchodilator

Question 10

Asthma - presentation

Answer 10

• Wheeze
• Shortness of breath
  
  • At rest
• Cough
  
  • Dry

Question 11

Asthma - differentials

Answer 11

• Onset <5
  
  • Congenital
  • CF
  • PCD
  • Bronchitis
  • Foreign body
• 5 or more years
  
  • Dysfunctional breathing
  • Vocal cord dysfunction
  • Habitual cough
  • Pertussis

Question 12

What are principles for when the diagnosis can be asthma?

Answer 12

• All in the history, examination unhelpful
  
  • Unlikely to be wheezing unless having attack
• No diagnostic asthma test
  
  • Tests can be useful for exclusion
• Wheeze is a must have symptom
  
  • But not in isolation – with cough and SOB
  • Most people wrongly describe noise as wheeze when is actually a rattle and not whistle
• Personal history
  
  • Parental asthma
  • Other conditions such as eczema
• Responds to treatment
  
  • 2 month course of ICS

Question 13

How does epidemiology of asthma diagnosis change with age?

Answer 13

• Under 18 months
  
  • Most likely infection, but can be asthma
• Over 5 years
  
  • Most likely asthma