Asthma

Medicine > Respiratory

Background knowledge 🧠

Definition

Asthma is a chronic inflammatory disorder of the airways resulting in recurrent and reversible bronchoconstriction.
Characterised by airway hyperresponsiveness and chronic airway inflammation.

Aetiology

Allergens: Pollen, dust mites, pet dander.
Occupational: Chemicals, dust, fumes.
Respiratory infections.
Exercise.
Drugs: NSAIDs, beta-blockers.
Gastroesophageal reflux disease (GERD).

Clinical Features 🌡️

Clinical Features

Episodic breathlessness.
Wheezing.
Cough, often nocturnal.
Chest tightness.

Investigations 🧪

Tests

Spirometry: Reduced FEV1/FVC ratio, reversibility with bronchodilator.
Peak expiratory flow rate (PEFR) monitoring.
Allergy testing.
Blood tests: eosinophil count, IgE levels.

Management 🥼

Management

Relievers: Short-acting beta-agonists (SABA) e.g., salbutamol.
Preventers:
- Inhaled corticosteroids (ICS) e.g., beclomethasone.
- Long-acting beta-agonists (LABA) e.g., formoterol.
- Leukotriene receptor antagonists e.g., montelukast.
Acute severe asthma (Asthma attack):
- Oxygen.
- Nebulised SABA.
- Systemic corticosteroids.
Education and self-management: asthma action plan.
Eliminate aggravating factors (e.g., avoid allergens, smoking cessation).

Prognosis

Variable.
Most have good control with treatment, but some may progress to chronic respiratory impairment.

Complications

Status asthmaticus (severe asthma not responding to treatment).
Chronic obstructive pulmonary disease (COPD).
Respiratory failure.

Key Points

Asthma is characterised by airway hyperresponsiveness and chronic airway inflammation with variable airflow obstruction.
It is defined by the history of one of more respiratory symptoms such as a wheeze, episodic breathlessness, chest tightness and cough that vary overtime and in intensity.
Variable airflow obstruction is observed through reversibility with bronchodilator in spirometry.
Stepwise management with inhaled therapy is required (relievers and preventers).
Patient education and adherence is crucial to prevent progression and asthma attacks.

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💡 We've found 7 questions

Average

Platform average

32557

Clinical features that increase the probability of asthma include:

28452

A 12-year-old boy presents to the emergency department with worsening shortness of breath and a wheeze for the last 24 hours. On examination, he has a respiratory rate of 35/min and has bilateral wheeze on auscultation. You suspect he has a severe exacerbation of asthma.

What would you expect his peak flow to be?

32429

Which of the following is not a sign of life-threatening asthma in an adult?

30149

A tension pneumothorax:

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3.23% of users got this question correct

Answer Explanation:

The correct answer is “Is treated by aspiration of air from the second intercostal space in the mid-clavicular line”. This is because a tension pneumothorax is a life-threatening condition that requires immediate treatment to remove the trapped air in the pleural space. This is typically done by needle decompression (aspiration) at the second intercostal space in the mid-clavicular line.

Incorrect Options Explanation:

“Should be diagnosed by a posteroanterior (PA) chest X-ray” – While a chest X-ray can confirm a pneumothorax, a tension pneumothorax is a clinical diagnosis and should be treated immediately based on symptoms and physical examination findings, not waiting for imaging.
“Leads to tracheal deviation towards the affected side” – This is incorrect. A tension pneumothorax actually causes tracheal deviation away from the affected side due to the pressure pushing the mediastinum to the opposite side.
“Is common in young, tall, slim men” – This is a characteristic of primary spontaneous pneumothorax, not specifically tension pneumothorax.
“Is more common than simple pneumothorax” – This is incorrect. Simple pneumothorax is more common than tension pneumothorax.

Overview of Tension Pneumothorax:

A tension pneumothorax is a life-threatening condition where air enters the pleural space and cannot escape, leading to a build-up of pressure that compresses the lungs and shifts the mediastinum.
Clinical Presentation: Patients often present with severe shortness of breath, chest pain, increased heart rate, low blood pressure, and decreased oxygen saturation. On physical examination, there may be decreased breath sounds and hyperresonance on the affected side, and tracheal deviation away from the affected side.
Treatment: Immediate needle decompression (aspiration) at the second intercostal space in the mid-clavicular line, followed by chest tube insertion to prevent reaccumulation of air.

28584

A 7-year-old boy has a chronic cough and wheeze. He had a good response to a β-agonist, demonstrated by his peak expiratory flow rate (PEFR). He was initially managed with a short-acting β-agonist, but his symptoms persisted and a regular inhaled steroid was added (400 μg/day).

If no improvement is seen, which of the following would be the next step in the management?

28467

You are asked to see a 7-year-old boy in the emergency department who has a history of asthma. He says he had a cold yesterday and now presents with a 6-hour history of ‘feeling tight’. On arriving, he tells that he is disappointed to be here as he was going to see Leeds United this afternoon. On examination, he has equal air entry bilaterally associated with a loud polyphonic wheeze. His saturations are 93% in air and his peak expiratory flow rate is 60% of his best in clinic. His heart rate is 110/min and his respiratory rate is 28/min.

Which of the following would be your most immediate step?

28130

A 35-year-old woman is admitted to hospital with acute-onset shortness of breath. She has a past medical history of asthma. Her observations include a pulse rate 120 bpm, blood pressure 100/72 mmHg, respiratory rate 30/min and SaO₂ 88% on room air. On examination, she appears to be drowsy and exhausted. Her chest is quiet on auscultation.

Arterial blood gases show: pH 7.35, PaO₂ 7.2 kPa, PaCO₂ 4.9 kPa and bicarbonate 24 mmol/L.

Which of the following would not be appropriate in the management of this case?

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