Asthma, A Clincal Perspective

• What is the definition of asthma?

  Chronic inflammatory condition of the airways characterised by bronchial hypersensitivity to a variety of stimuli (triggers) leading to variable airway obstruction
• What are the different types of asthma?

  Cough variant

  Eosinophilic

  Non-eosinophilis

  Occupational

  Chronic asthma with fixed airflow obstruction

  Exercise induced bronchospasm
• What is the airway obstruction in asthma due to?

  Inflammatory cell infiltration

  Mucous hypersecretion & plugginh

  Smooth muscle contraction
• What are the triggers of asthma?

  Weather (seasonal)

  Lower resp tract infection

  Food

  Pollution

  Cigarette smoke

  Emotion/stress

  Mould/damp

  Pets

  Exercise

  Dust

  Pollen

  Drugs (NSAIDs)
• What is the acute presentation of asthma?

  SOB

  Cough +/- green phlegm

  Chest pain/tightness

  Difficulty completing sentences

  Wheeze
• What is a chronic presentation of asthma?

  Coughing & wheezing are the most common symptoms of childhood asthma

  SOB, chest tightness/pressure

  Poor school performance & fatigue -> indicate sleep deprivation from nocturnal symptoms
• What are markers of poor prognosis in asthma?

  Previous acute admission and/or intubation

  3+ different classes of asthma medication

  Pscyhosocial dysfunction

  Inadequately treated disease

  Smoking
• What is included in a 'good asthma history'?

  How many times a week do you use SABA (3+ is indicative of poor control)

  What are your triggers/pets

  How many courses of steroids in the last year

  How often do you forget to use your inhalers

  Smoking status

  Job

  Exercise

  Anxiety element

  'Vocal hygiene"
• What is wheeze?

  High-pitched, expiratory sound -> produced when air is forced through narrow airways

  Asthma wheeze tends to be polyphonic
• What are the differential diagnosis for asthma?

  COPD

  Upper airway obstruction

  Hyperventilation syndrome

  Anxiety

  Gastro-oesophageal syndrome

  Pulmonary oedema

  Interstitial lung disease

  Pulmonary HTN
• What is inducible laryngeal obstruction?

  Functional condition where airways become hypersensitive

  Marked inspiratory noise & may have voice changes

  
• What are the signs of good asthma control?

  No daytime symptoms

  No night-time awakening due to asthma

  No need for rescue medication

  No exacerbations

  No limitations on activity (inc. exercise)

  Normal lung function

  Minimal side effects from medication
• What are triple devices for asthma?

  ICS, LABA, LAMA all in one inhaler?
• Why are muscarinic antagonists used in asthma?

  Blocks cholinergic tone at airway smooth muscle

  e.g. tiotropium
• What is the acute treatment of asthma?

  ABCDE

  O2 to maintain sats > 94%

  Corticosteroids (oral > parenteral)

  Nublised bronchodilators

  IV MgSO4 (if severe asthma is not responding)

  Antiobiotics -> ONLY is suspect superimposed bacterial infection
• What is the ongoing care of asthma?

  Self management plans

  Patient education

  Use of apps/telemedicine

  Annual GP review (asthma nurse)

  Secondary care review for more advanced cases
• Fill in the blanks

  A) Moderate Acute

  B) Acute Severe

  C) Life-threatening

  D) Near-fatal

  
• What are the investigations for asthma?

  Peak Expiratory Flow Rate variability

  Spirometry

  FeNO

  Bronchial provocation (challenge test)
• What is a risk of using ICS?

  Oral thrush

  Important to rinse mouth after using ICS inhaler
• What does mepolizumab target?

  IL-5
• What does reslizumab target?

  IL-5
• What does benralizumab target?

  IL-5 receptor
• What does dupilumab target?

  IL-4

  IL-13

  IL-4 receptor