Session 5 - Asthma

Question 1

Describe the epidemiology of asthma

Answer 1

• Increasing in prevalence
• More common in the developed world
• Increases in populations who move from developing to developed countries

Question 2

How many adults currently receive tratment for asthma?

Answer 2

• 5.4 million

Question 3

What are the potential causes of asthma?

Answer 3

• Genetic risk
• Sensitisation to airborne allergens 
	○ House dust mite
	○ Pollens
	○ Air pollution 
	○ Tobacco smoke
• Hygiene hypothesis

Question 4

hat is the definition of asthma?

Answer 4

• One or more of the following recurring symptoms
	○ Wheeze
	○ Cough
	○ Breathlessness
	○ Chest tightness
	○ Variable airflow obstruction

Question 5

What is a wheeze?

Answer 5

• High pitched expiratory sound
• Originates in airways compressed or obstructed
• Wheeze is of variable intensity and tone

Question 6

Outline the type of cough one may develop in asthma

Answer 6

• Cough that’s worse at night
• Cough which is exercise induced
• Dry cough

Question 7

What are the three parts of the examination of a suspected asthma patient?

Answer 7

• Inspection
• Percussion
• Auscultation

Question 8

What do you look for in the inspection of an asthma patient?

Answer 8

• Chest 
	○ Scars/deformities
	○ Hyper expansion
• General health
	○ Eczema, hay fever
	○ Lethargu
	○ Can they speak?

Question 9

What are you looking for in percussion of an asthma patient?

Answer 9

• Hyper-resonance

Question 10

What are you looking for in auscultation of an asthma patient?

Answer 10

• Polyphonic wheeze

Question 11

Give three tests used in the investigation of an asthma patient?

Answer 11

• Spirometry - Flow volume loop
• Allergy testing
• Chest x-rays

Question 12

What will you see in the spirometry of an asthmatic?

Answer 12

• Low PERF?
• Low FEV/FVC ratio
• > 12% increase in FEV1 following salbutamol

Question 13

What will you see in the allergy testing of an asthmatic?

Answer 13

• Skin prick to aero allergens

* Blood IgF levels to specific aero-allergens

Question 14

What will you see in Chest X ray of asthmatic?

Answer 14

• Peformed to exclude other disease/inhalation of foreign body/pneumothorax

Question 15

Outline the pathophiologyical changes underlying asthma

Answer 15

• Increased mast cells
• Increased eosinophils
• Increased dendritic cells

Question 16

What role do mast cells play in asthma?

Answer 16

• Release prostaglandins/histamine

Question 17

What role do eosionphils play is asthma?

Answer 17

Large numbers in bronchial wall of asthmatics

Question 18

What role do dendritic cells and lymphocytes have in asthna?

Answer 18

• Dedritic cells have a role in the initial uptake and presentation of allergens to lymphocytes
• T-Helper lymphocytes (CD4) release cytokines that play a key part in the activation of mast cells
• Th2 phenotype favour the production of antibody production by B lymphocytes to IgE.

Question 19

What occurs in remodelling in asthma?

Answer 19

• Epithelium
○ Stressed and damaged with a loss of ciliated columnar cells
• Basement membrane
○ Deposition of collagens, causing it to thicken
• Smooth Muscle
○ Hyperplasia causing thickening of the muscle

Question 20

Give three causes of asthmatic attacks?

Answer 20

• Lack of treatment adherence
• Respiratory virus infections associated with common cold
• Exposure to allergens or triggering drug

Question 21

What are three treatments for asthma?

Answer 21

• Education
• Primary prevention
• Pharmacological management

Question 22

What does education do for asthma patients?

Answer 22

• Educates people to correctly recognise their symptoms
○ To use services appropriately
○ To develop own personal asthma action plan

Question 23

What is primary prevention of asthma?

Answer 23

• Stop smoking
• Get fresh air
• Reduce exposure to allergens
• Lose weight

Question 24

What is involved in the pharmacological management of asthma?

Answer 24

• B2 adrenoagonists
○ Muscarinic antagonists
• Anti inflammatory agents