Asthma Overview and History Quiz

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Questions and Answers

Which medication is recommended for managing asthma by controlling inflammation?

Theophyllines

Long acting B2 agonists

Inhaled steroids (correct)

Leukotriene receptor antagonists

What should be considered as triggers in asthma management?

Diet and nutrition

Family history of asthma

Allergies and occupation (correct)

Previous hospital admissions

What is a key characteristic of COPD?

History of asthma in childhood

Reversible airway obstruction

Irreversible airways disease (correct)

Only affects smokers

How can peak flow measurements assist in asthma management?

Monitoring asthma control and severity Signup and view all the answers

Which of the following statements about nebulisers is correct?

Salbutamol is commonly used in nebulisers. Signup and view all the answers

What does the anti-IgE medication, omalizumab, primarily target?

IgE-mediated allergic reactions Signup and view all the answers

What is the recommended approach to assess COPD severity?

Assessment of productive cough duration Signup and view all the answers

What does bronchial thermoplasty aim to improve in asthma management?

Decrease smooth muscle mass Signup and view all the answers

Which of the following symptoms is typically associated with asthma?

Nocturnal cough Signup and view all the answers

What is a key diagnostic clue indicating COPD?

Slowly progressive symptoms Signup and view all the answers

Which of the following is NOT a common trigger for asthma symptoms?

Swollen leg Signup and view all the answers

What is a common risk factor for pulmonary embolism (PE)?

Obesity and immobility Signup and view all the answers

Which statement regarding lung cancer is true?

It is the third biggest cause of death. Signup and view all the answers

Which of the following findings is indicative of a pneumothorax?

Quiet breath sounds Signup and view all the answers

Which condition is most likely characterized by inspiratory wheeze?

Asthma Signup and view all the answers

What is the economic burden of asthma on the NHS?

£3 billion Signup and view all the answers

What is the primary goal of using a Peak Flow diary in asthma management?

To monitor asthma control Signup and view all the answers

Which of the following is NOT considered a common trigger for asthma exacerbations?

Exercise-induced hypertension Signup and view all the answers

In COPD management, which medication class is primarily used for immediate relief of symptoms?

Short-acting beta agonists (SABA) Signup and view all the answers

What diagnostic investigation is primarily used to evaluate suspected pulmonary embolism (PE)?

CT scan Signup and view all the answers

What is a characteristic clinical sign of lung cancer that differentiates it from other respiratory conditions?

Weight loss Signup and view all the answers

Which of these treatment strategies is recommended for patients with asthma as a preventer?

Inhaled corticosteroids Signup and view all the answers

How does smoking influence asthma management?

It can worsen symptoms and increase exacerbations Signup and view all the answers

Which of the following leisure activities is linked to occupational exposure as a potential asthma trigger?

Woodworking Signup and view all the answers

What respiratory investigation is used to assess blood gases and oxygenation status?

Arterial blood gas (ABG) analysis Signup and view all the answers

According to Ockham's razor, what principle should guide clinical diagnosis?

The simplest explanation is usually correct Signup and view all the answers

Which of the following respiratory conditions has the highest economic burden on the NHS?

Asthma Signup and view all the answers

Which symptom is not commonly associated with lower respiratory tract conditions?

Cyanosis of the lips Signup and view all the answers

What is a significant risk factor that contributes to higher mortality rates in respiratory diseases?

Low socioeconomic status Signup and view all the answers

Which of the following is a characteristic sign that may indicate heart failure rather than a respiratory condition?

Swollen ankles Signup and view all the answers

In evaluating potential pneumonia, which symptom is most commonly associated with this respiratory condition?

Fever and chills Signup and view all the answers

Which diagnostic clue might suggest the presence of a pulmonary embolism (PE)?

Swollen leg alongside risk factors Signup and view all the answers

Which general symptom is least likely to be a trigger for asthma exacerbations according to common clinical understanding?

Frequent hydration Signup and view all the answers

What is a primary physiological sign that differentiates asthma from chronic obstructive pulmonary disease (COPD)?

Peaked flow readings Signup and view all the answers

Which condition is suggested by dry cough and crackles along with occupational exposure?

Interstitial lung disease Signup and view all the answers

Which of the following statements best describes Ockham's razor?

The simplest explanation is often the most accurate. Signup and view all the answers

What is a key indication of asthma severity during physical examination?

Not speaking in full sentences Signup and view all the answers

Which of the following respiratory investigations is primarily used to diagnose asthma?

Spirometry Signup and view all the answers

What common respiratory sign is observed in asthma but may also indicate a serious condition if life-threatening?

Cyanosis Signup and view all the answers

Which risk factor is linked to an increase in asthma exacerbations?

Exposure to triggers Signup and view all the answers

What type of respiratory sound would most likely indicate an obstruction?

Wheezing Signup and view all the answers

Which component in respiratory investigations is used to evaluate chronic diseases like COPD and asthma?

Spirometry Signup and view all the answers

Which of the following treatments is primarily aimed at providing prolonged control of asthma symptoms?

Long Acting Beta Agonist (LABA) Signup and view all the answers

Which investigative method is used to analyze blood gas levels in patients with respiratory conditions?

Arterial Blood Gas (ABG) analysis Signup and view all the answers

What is a significant aspect of managing asthma exacerbations effectively?

Using inhaled steroids as the first-line treatment Signup and view all the answers

In the context of asthma medications, which combination is most effective as a maintenance treatment?

Inhaled corticosteroids combined with long-acting B2 agonists Signup and view all the answers

What does the peak expiratory flow rate (PEFR) monitoring help to indicate in asthma patients?

The potential severity of an asthma exacerbation Signup and view all the answers

What is a common misconception regarding the use of nebulisers in asthma management?

Nebulisers can replace the need for inhaled medications Signup and view all the answers

Which physiological mechanism primarily drives eosinophil-mediated asthma?

Activation of IgE antibodies against allergens Signup and view all the answers

In chronic obstructive pulmonary disease (COPD), what is the primary irreversible change that occurs within the lungs?

Progressive airway narrowing and obstruction Signup and view all the answers

What is a critical consideration when assessing triggers in asthma management?

Including occupational exposures in assessments Signup and view all the answers

In asthma management, which treatment is specifically designed for patients with IgE-driven disease?

Anti-IgE therapies like omalizumab Signup and view all the answers

Which of the following respiratory conditions is associated with a variable wheeze and nocturnal cough?

Asthma Signup and view all the answers

Which clinical symptom is indicative of a possible pneumothorax?

Pleuritic pain Signup and view all the answers

What characteristic feature distinguishes COPD from asthma during evaluation?

Gradual progression of symptoms Signup and view all the answers

Which sign is most likely associated with heart failure rather than a primary respiratory condition?

Swollen ankles Signup and view all the answers

Which factor is most likely to contribute to higher mortality rates in respiratory diseases within disadvantaged groups?

Higher exposure to air pollution Signup and view all the answers

Which respiratory investigation is primarily used to assess for infections, fibrosis, and cancer in the lungs?

Chest X-Ray (CXR) Signup and view all the answers

What characterizes asthma as opposed to chronic obstructive pulmonary disease (COPD)?

Hyper-responsive and reversible airway changes Signup and view all the answers

Which of the following factors may negatively impact a patient's asthma control?

Improper inhaler technique Signup and view all the answers

Which statement best describes Hickam's Dictum in the context of patient diagnosis?

A patient can have as many diseases as they wish. Signup and view all the answers

What type of respiratory sound is commonly associated with obstruction?

Stridor Signup and view all the answers

During an asthma exacerbation, which clinical sign typically indicates the severity of the condition?

Patient ability to speak in full sentences Signup and view all the answers

Which of the following is a key feature of chronic inflammation seen in asthma?

Mucus hypersecretion Signup and view all the answers

What does an elevated d-dimer level in bloodwork typically indicate?

Pulmonary embolism Signup and view all the answers

Which risk factor is most commonly linked to childhood asthma exacerbations?

Previous hospitalizations for respiratory issues Signup and view all the answers

Which condition is most likely indicated by the combination of pleurisy and a productive cough?

Pneumonia Signup and view all the answers

Study Notes

Asthma

Common, atopic patient
Chronic inflammation of the airways
Hyper-responsive and reversible
Inflammatory cells infiltrate the airways
Smooth muscle hypertrophy
Thickening of the airway
Trigger by pollution, occupational exposure, allergens, bacteria and viruses, cold air

Asthma History

Risk factors: smoking, family history, childhood infections, pollution, prematurity, occupation (chemicals, dusts, spores)
Key history points: Wheeze, have they ever been hospitalised/ITU admission, have they required steroids/rescue pack, nocturnal cough, worse at night, worse at work/better on holiday, atopy, eczema, hayfever, illness (viral/bacteria)
Risks of exacerbations: poor inhaler technique, continued triggers, smoking (active vs passive)

Asthma signs and investigations

Wheeze
Dry cough (unless infected)
Breathlessness (usually acutely, progressive while unwell, responsive to treatment (usually))
Not speaking in full sentences (acute)
Hypoxia and cyanosis in life-threatening exacerbations

Peak flow

Twice a day
Know their best and calculate predicted

Asthma summary management

Peak flow diary
Stop smoking/vaping
Avoid/limit triggers
Vaccinations (Flu)
Inhalers: B2 agonist (salbutamol): relief (BLUE) (SABA), steroid: preventer (BROWN) (ICS), long acting B2 agonist (LABA), Combo (Fostair (LABA/ICS), Symbicort (LABA/ICS))
CHECK inhaler technique!

COPD

Emphysema & Chronic bronchitis
Over a million GP appointments a year
Smoking: >80% cause
Irreversible airways disease

Respiratory investigations

Bloodwork: Anaemia, infection, eosinophilia, BNP, calcium, thyroid, ?d-dimer, cultures
Peak flow: Asthma
Spirometry: COPD, asthma, fibrosis
Chest X-Ray (CXR): infection, fibrosis, cancer, collapse
CT scan: PE, cancer, fibrosis, complex infections
Sleep studies/overnight oximetry: Obstructive sleep apnoea
ABG: Hypoxia, COPD, Asthma

Common respiratory conditions with associated investigations

Asthma: common, atopic patient, chronic inflammation of the airways, hyper-responsive and reversible, inflammatory cells infiltrate the airways, smooth muscle hypertrophy, thickening of the airway, trigger by pollution, occupational exposure, allergens, bacteria and viruses, cold air
COPD: slowly progressive, smoking, low peak flow

Diagnostic clues:

Is it asthma? Variable, wheeze, nocturnal cough, triggers, atopy, low peak flow
Is it COPD? Slowly progressive, smoking, low peak flow
Is it a pneumothorax? Pleuritic pain, quiet breath sounds, CXR findings
Is it a PE? Risk factors (immobility, malignancy, previous PE/DVT), pleurisy, haemoptysis, swollen leg
Is it heart failure? Swollen ankles, orthopnoea, crackles, JVP
Is it pneumonia? Fever, rigors, pleurisy, productive cough, bronchial breathing, crackles, CXR- Consolidation
Is it cancer? Smoking, weight loss, PMH (?secondary cancer)
Is it interstitial lung disease? Occupational exposure, hobbies, drugs, crackles, dry cough
Sore throat/Rhinorrhoea: Upper respiratory tract infection (URTI)
Stridor: Obstruction

Respiratory sounds

Crackles: wet vs dry, coarse
Bronchial breathing: hollow sound
Wheeze: inspiratory (stridor), expiratory

Who are these people?

Ockham’s Razor: theory that the simplest explanation is the correct one!
Hickam’s dictum: ‘A patient can have as many diseases as they damn well please!’
Remember that many things might be going on at once, patients often have many co-morbidities!

Burden of respiratory disease

3rd biggest cause of death
Lung cancer
COPD
Asthma
All: £11 billion to the NHS
Mortality rates higher in disadvantaged groups

Respiratory Disease Burden

Respiratory diseases are the third biggest cause of death
1 in 5 people are affected by respiratory conditions
Increased incidence over winter
Asthma: £3 Billion, COPD: £1.9 Billion, total NHS cost: £11 Billion
Higher mortality in disadvantaged groups due to smoking, air pollution, poor housing, occupational hazards

Respiratory Anatomy & Physiology

Covers the structure and function of the respiratory system

Common Respiratory Symptoms & Signs

Upper Respiratory Tract: Rhinorrhoea, Nasal congestion, Sore throat
Lower Respiratory Tract: Breathlessness, Haemoptysis, Cough (productive/dry/nocturnal), Wheeze (inspiratory/expiratory)
Other signs: Cyanosis of lips/earlobes/fingertips, Crackles (wet/dry/coarse), Bronchial breathing (hollow sound)

Diagnostic Clues

Asthma: Variable wheeze, nocturnal cough, triggers, atopy, low peak flow
COPD: Slowly progressive, smoking, low peak flow
Pneumothorax: Pleuritic pain, quiet breath sounds, CXR findings
PE: Risk factors (immobility, malignancy, previous PE/DVT), pleurisy, haemoptysis, swollen leg
Heart failure: Swollen ankles, orthopnoea, crackles, JVP
Pneumonia: Fever, rigors, pleurisy, productive cough, bronchial breathing, crackles, CXR- consolidation
Cancer: Smoking, weight loss, past medical history (secondary cancer)
Interstitial lung disease: Occupational exposure, hobbies, drugs, crackles, dry cough
Sore throat/Rhinorrhoea: Upper respiratory tract infection (URTI)
Stridor: Obstruction

Ockham's Razor & Hickam's Dictum

Ockham's Razor: The simplest explanation is usually the correct one
Hickam's Dictum: A patient can have many diseases at the same time

Respiratory Investigations

Bloodwork: Anaemia, infection, eosinophilia, BNP, calcium, thyroid, d-dimer, cultures
Peak flow: Asthma
Spirometry: COPD, asthma, fibrosis
Chest X-Ray (CXR): Infection, fibrosis, cancer, collapse
CT Scan: PE, cancer, fibrosis, complex infections
Sleep studies/overnight oximetry: Obstructive sleep apnoea
ABG: Hypoxia, COPD, Asthma

Common Respiratory Conditions

Describes common respiratory conditions with associated investigations

Asthma

Common, atopic patient
Chronic inflammation of the airways
Hyper-responsive and reversible
Inflammatory cells infiltrate the airways
Smooth muscle hypertrophy
Thickening of the airway
Triggered by pollution, occupational exposure, allergens, bacteria/viruses, cold air

Asthma History

Risk factors: Smoking, family history, childhood infections, pollution, prematurity, occupation (chemicals, dusts, spores)
Key history points: Wheeze, hospitalisation, ITU admission, steroid use, rescue pack requirement, nocturnal cough, worse at night, worse at work/better on holiday, atopy (eczema, hayfever), illness, viral/bacterial infections

Asthma Signs & Investigations

Signs: Wheeze, dry cough, breathlessness (acute, progressive), responsive to treatment, not speaking in full sentences (acute), hypoxia and cyanosis in life-threatening exacerbations
Investigations: Peak flow (twice a day), bloods (IgE, eosinophils), spirometry (obstructive), CXR, sputum sample

Asthma Management (Non-acute)

Peak flow diary: Monitor control
Inhalers:
- B2 agonist [salbutamol]: Relief
- Steroid: preventer
- Long acting B2 agonist (LABA)
- Combo inhalers (LABA/ICS)
Other interventions: Stop smoking/vaping, avoid/limit triggers, vaccinations (flu, Covid), check inhaler technique (use spacer when possible), annual review, tablets if poor control, leukotriene antagonists, theophylline, steroids

Asthma Phenotypes

There are different types of asthma

BTS/SIGN Asthma Guidelines

Provide guidance on managing asthma

Asthma Management Principles

Consider triggers (allergies, occupation)
Ensure concordance (engagement) and check inhaler technique
Control inflammation with inhaled steroids
Use long acting B2 agonists (ICS/LABA inhalers)
Consider leukotriene receptor antagonists, theophyllines, long acting anticholinergics (tiotropium)

Nebulisers

Used in asthma and COPD
Contents: Salbutamol 2.5mg, Ipratropium 500 micrograms, Saline nebs
Used for specific antibiotics in CF/bronchiectasis (Colomycin, gentamicin)

Spacers

10 puffs in a spacer is the same as a neb
No need for patients to buy expensive machines

Advanced Asthma Treatment

IgE-driven disease: Anti IgE (omalizumab)
Eosinophil-driven disease: Anti IL-5 (mepolizumab...), Anti IL-4 alpha subunit
Bronchial thermoplasty: Treatment for severe asthma

Asthma Discharge Checklist

Provides information for patients leaving hospital following an asthma admission

Peak Flow

Common measure of airflow in and out of the lungs
Monitors asthma control
Guides assessment of asthma exacerbation severity

Peak Flow Recording

Stand up, deep breath in, seal mouth, short exhale, best of three attempts
Record twice a day
Patients know their usual PEFR
Predicted based on height

Acute Asthma Severity

There are different levels of asthma severity in acute presentations

Emphysema & Chronic Bronchitis

COPD: Emphysema and Chronic bronchitis combined
Chronic productive cough for at least 2 consecutive years
2nd commonest cause of hospital admission
Over 1 million GP appointments a year
Irreversible airways disease
80% caused by smoking

Main Problems with COPD

Details the key issues associated with COPD

Introduction

Respiratory diseases are the 3rd leading cause of death.
One in five people are affected by respiratory diseases.
Respiratory diseases are a significant burden on the NHS, costing £11 billion annually.
Mortality rates are higher in disadvantaged groups due to factors like smoking, air pollution, poor housing, and occupational hazards.

Common Respiratory Conditions & Symptoms

Upper Respiratory Tract
- Rhinorrhea (runny nose)
- Nasal Congestion
- Sore Throat
Lower Respiratory Tract
- Breathlessness
- Haemoptysis (coughing up blood)
- Cough (productive/dry, nocturnal)
Signs
- Cyanosis (blue discoloration of lips, earlobes, fingertips)
- Crackles in the lungs (wet/dry, coarse)
- Bronchial breathing
- Wheeze (inspiratory/expiratory)

Diagnostic Clues

Asthma
- Variable symptoms,wheeze, nocturnal cough, triggers, atopy (allergies), low peak flow
COPD
- Slowly progressive, smoking history, low peak flow
Pneumothorax
- Pleuritic pain (sharp chest pain), quiet breath sounds, chest X-ray findings
Pulmonary Embolism (PE)
- Risk factors: Immobility, malignancy, previous PE/DVT, pleurisy, haemoptysis, swollen leg
Heart Failure
- Swollen ankles, orthopnea (difficulty breathing when lying down), crackles, JVP (jugular venous pressure)
Pneumonia
- Fever, rigors (shivering), pleurisy, productive cough, bronchial breathing, crackles, consolidation on chest X-ray
Cancer
- Smoking history, weight loss, previous history of cancer
Interstitial Lung Disease
- Occupational exposure, hobbies, medications, crackles, dry cough
Sore throat/Rhinorrhea
- Upper Respiratory Tract Infection (URTI)
Stridor
- Obstruction

Ockham’s Razor and Hickam’s Dictum

Ockham’s Razor: The simplest explanation is often the correct one.
Hickam’s Dictum: A patient can have as many diseases as they damn well please.

Respiratory Investigations

Bloodwork
- Anaemia, infection, eosinophilia (elevated eosinophils), BNP (brain natriuretic peptide), calcium, thyroid, D-dimer, cultures
Peak Flow
- Used to monitor asthma control
Spirometry
- COPD, asthma, fibrosis
Chest X-Ray (CXR)
- Infection, fibrosis, cancer, collapse
CT Scan
- PE, cancer, fibrosis, complex infections
Sleep Studies/Overnight Oximetry
- Obstructive sleep apnea
ABG (Arterial Blood Gas)
- Hypoxia (low oxygen levels), COPD, asthma

Asthma

Common atopic (allergic) condition
Chronic inflammation of the airways, causing hyperresponsiveness and reversibility
Inflammatory cells infiltrate the airways
Smooth muscle hypertrophy (thickening)
Thickening of the airway wall
Triggers: Pollution, occupational exposure, allergens, virus/bacteria, cold air

Asthma History

Risk factors:
- Smoking
- Family history
- Childhood infections
- Pollution
- Prematurity
- Occupation (chemicals, dusts, spores)
Key history points:
- Wheeze
- Hospitalization/ITU admissions
- Use of steroids/rescue inhalers
- Nocturnal cough
- Worsening symptoms at night
- Improvement on holiday
- Atopy (eczema, hayfever)
- Exacerbation risks: Poor inhaler technique, continued triggers, smoking, illness

Asthma Signs & Investigations

Signs:
- Wheeze
- Dry cough (unless infected)
- Breathlessness (acute or progressive)
- Responsive to treatment (usually)
- Difficulty speaking in full sentences (acute)
- Hypoxia and cyanosis during severe exacerbations
Investigations:
- Peak flow (twice daily)
- Bloods: IgE, eosinophils
- Spirometry (obstructive pattern)
- Chest X-ray
- Sputum sample

Asthma Management (Not Acute)

Peak flow diary: Monitoring control
Inhalers:
- Short-acting beta-agonist (SABA) (salbutamol): Relief
- Inhaled corticosteroids (ICS): Prevention
- Long-acting beta-agonist (LABA)
- Combined inhalers (ICS/LABA)
Other interventions:
- Smoking cessation
- Avoidance/limitation of triggers
- Vaccinations (influenza, COVID)
- Annual review
Other medications:
- Leukotriene antagonists
- Theophylline
- Steroids (oral)

Asthma Phenotypes

Different asthma phenotypes (types) exist.

BTS/SIGN Asthma Guidelines

Consider triggers: Allergies and occupation.
Ensure concordance and correct inhaler technique.
Control inflammation with inhaled steroids, long-acting beta-agonists, leukotriene receptor antagonists, theophylline, and long-acting anticholinergics (tiotropium).

Nebulisers

Used in asthma and COPD
Commonly used medications in a nebulizer: Salbutamol, ipratropium bromide, saline
Used for certain antibiotics in cystic fibrosis and bronchiectasis

Importance of Spacers

Using a spacer with an inhaler can be as effective as a nebulizer.

Advanced Asthma Treatments

IgE-driven disease:
- Anti-IgE therapy (omalizumab)
Eosinophil-driven disease:
- Anti-IL5 therapy (mepolizumab, etc.)
- Anti-IL4 alpha subunit therapy
Bronchial thermoplasty:
- Heat treatment to reduce airway smooth muscle mass

Asthma Discharge

Patients should be provided with a discharge checklist to ensure understanding of their condition and management

Peak Flow

Used to monitor asthma control.
Simple measurement of air flow in and out of the lungs.
Can help assess asthma exacerbation severity.
Recommendations:
- Record standing upright.
- Deep breath in, form a seal around the mouth, short, sharp breath out.
- Perform three attempts and record the highest reading.
- Record twice daily.
- Patients should know their usual peak flow readings.
- A predicted peak flow can be calculated based on height.

Acute Asthma Severity

Severity of an acute asthma exacerbation can be classified using guidelines.

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Description

Test your knowledge on asthma, its risk factors, and the key historical points to consider when assessing patients. This quiz covers aspects of chronic inflammation, signs, and potential triggers associated with asthma to prepare you for clinical scenarios. Ideal for medical students and healthcare professionals.