Asthma

• What is asthma?

  Chronic inflammation characterised by bronchial hypersensitivity to a variety of triggers
• What type of disorder is asthma?

  Obstructive lung disease
• What are the 2 main types of asthma?

  Extrinsic (atopic)

  Intrinsic (non-atopic)
• What triggers extrinsic asthma?

  Identifiable allergen
• What mediates a response in extrinsic asthma?

  Systemic IgE (type 1 hypersensitivity)
• What is intrinsic asthma due to?

  Genetic/ environmental factors
• What is intrinsic asthma associated with?

  Chronic bronchitis

  Stress

  Anxiety

  Strenuous excercise

  Smoking
• What do we look at to classify asthma severity?

  Frequency of symptoms

  FEV1

  PEFR

  Frequency of medication use
• What is the atopic triad?

  Asthma

  Atopic dermatits

  Atopic rhinitis
• What are 9 risk factors for asthma?

  Personal/family history of atopy

  Low birth weight

  Exposure to allergens/ air pollution

  Obesity

  Ethnicity

  Smoking

  Drugs

  Occupation

  Hygiene hypothesis
• What 2 drugs are contraindicated in/linked to causing asthma?

  NSAID e.g. aspirin

  Beta-blockers
• Why should beta-blockers not be used in asthma?

  Stop action of adrenaline/NA on lungs = prevents bronchial SM relaxation = contrict airways
• What are 6 signs and symptoms of asthma?

  SOB

  Cough

  Wheeze

  Chest tightness

  Hyperinflated chest

  Sputum
• When does an asthma cough common occur during the day?

  Night/morning
• When is a wheeze commonly heard in asthma?

  On exhalation - usually polyphonic wheeze
• What are 11 asthma triggers?

  Weather

  Food

  Pollution

  Cigarette smoke

  Mould/damp

  Pets

  Exercise

  Dust

  Pollen

  Drugs

  lower resp tract infections
• What are some common allergic triggers in asthma?

  Dust mites

  Cockroach

  Furry pets

  Fungal spores
• What type of hypersensitivity is chronic asthma and why?

  Type 4

  Why: T cell involvement
• What three components make up the asthma triad?

  Bronchohyperresponsive

  Inflammation

  Airway obstruction
• What are 7 ddx for asthma?

  COPD

  CF

  GORD

  Lung cancer

  PE

  Intistial lung disease

  Dysfunctional breathing
• What are 8 signs and symptoms of an asthma attack?

  Silent chest

  Cyanosis

  Feeble resp effort

  Exhaustion

  Bradycardia

  Hypotensive

  Arrythmia

  Tachypnoea
• What is involved in the management of an asthma attack?

  Nebulised SABA/ anti-muscularinic

  IV hydrocortisone

  Oral prednisolone

  IV Mg sulfate

  IV B2 agonist

  Ventilation assistance
• What are 5 complications of asthma?

  Pneumonia

  Pneumothorax

  Resp failure

  COPD

  Resp alkalosis due to hyperventilation
• What blood tests would you do for asthma?

  WCC and CRP - check for infection

  Eosinophil count

  IgE - total IgE and specific IgE
• What tests are done for asthma?

  Bloods

  Sputum

  Spirometery

  Reversibility test

  Exhaled NO test

  Peak flow measurement

  CXR

  Allergy testing

  Resp exam
• What does a FEV1/FVC value >0.8 indicate?


  Restrictive disease
• What does a FEV1/FVC value <0.7 indicate?


  Obstructive disease
• What does the Exhaled NO Test measure?

  Inflammation
• What Exhaled NO Test result indicates inflammation?

  >40ppb
• What Peak Flow Measurement indicates Moderate Acute Asthma?

  50-70% of best/predicted value
• What Peak Flow Measurement indicates Severe Asthma?

  33-50%
• What Peak Flow Measurement indicates Life Thretaning Asthma?

  <33%
• What is the first line treatment for suspected Asthma?

  SABA e.g. salbutamol
• What is the first line treatment for confirmed Asthma?

  ICS
• What is the blue inhaler?

  Relief inhaler - usually contains a SABA
• What is the treatment pathway for Asthma?

  SABA

  Low dose ICS

  LABA/LTRA

  Higher dose ICS
• What is MART for Asthma?

  Maintenance and reliever therapy - form of combined LABA and ICS in a single inhaler
• What is the brown inhaler?

  Preventor inhaler - usually contains an ICS
• What is the problem of LT ICS use in asthma patients?

  Oral thrush
• What non-pharmacological methods may be used to manage Asthma?

  Avoid triggers

  Exercise

  Stop smoking

  Breathing exercises

  CAM

  Lose weight