Understanding Asthma and Its Triggers

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Questions and Answers

What characterizes asthma according to clinical definitions?

Excessive variation in lung function and respiratory symptoms (correct)

Permanent airway narrowing leading to respiratory failure

Constant airflow limitation without variation

Presence of chronic inflammation without symptoms

Which symptom is NOT typically associated with asthma?

Shortness of breath

Chronic chest pain (correct)

Wheezing

Coughing

In young children, how is asthma primarily diagnosed?

Lung function testing

Allergy testing

Family history of lung diseases

Presence of variable respiratory symptoms (correct)

What is a common characteristic of untreated asthma?

Chronic airway inflammation and hyperresponsiveness Signup and view all the answers

Which condition may have overlapping features with asthma in older patients?

Chronic obstructive pulmonary disease (COPD) Signup and view all the answers

What is the primary function of beta2 adrenoreceptors when stimulated?

Relax bronchial smooth muscle Signup and view all the answers

Why is LABA monotherapy not recommended in asthma treatment?

It is associated with an increased risk of asthma deaths. Signup and view all the answers

Which of the following adverse reactions is associated with the use of LABAs?

Tachycardia Signup and view all the answers

What should be regularly checked to ensure effective asthma management?

Inhaler technique and compliance Signup and view all the answers

In COPD treatment, LABAs can be used in combination with which of the following?

SAMAs and LAMAs Signup and view all the answers

What FEV1/FVC ratio indicates obstruction of the airways in adults?

Less than 0.75 to 0.8 Signup and view all the answers

Which of the following options correctly describes a characteristic of restriction in airflow?

It usually results from loss of elasticity or physical deformities. Signup and view all the answers

What is the first step in asthma management according to SIL?

Use SABA first Signup and view all the answers

Which medications are classified as short-acting beta agonists (SABA)?

Salbutamol and Terbutaline Signup and view all the answers

What is a common characteristic of short-acting beta agonists (SABA)?

They provide relief from acute symptoms in 5 to 15 minutes. Signup and view all the answers

Which combination of factors is essential for diagnosing asthma?

History, physical examination, and spirometry Signup and view all the answers

What defines expiratory airflow limitation in asthma diagnosis?

FEV1/FVC less than the lower limit of normal for age Signup and view all the answers

Which of the following is NOT a type of symptom associated with asthma?

Chronic fatigue Signup and view all the answers

What does spirometry primarily measure?

The volume of air inhaled and exhaled over time Signup and view all the answers

Which of the following is a sign indicating asthma?

Airway obstruction Signup and view all the answers

What does variable expiratory airflow limitation indicate in asthma?

Fluctuations in airflow limitation with varying conditions Signup and view all the answers

Which factor is NOT considered a potential trigger for asthma symptoms?

Daily exercise routine Signup and view all the answers

What role does spirometry play in asthma management?

Monitoring response to treatment Signup and view all the answers

Which patient group should exercise caution when using chewable tablets containing aspartame?

Patients with phenylketonuria Signup and view all the answers

What is the main action of leukotrienes in the context of asthma treatment?

They block chemicals that cause inflammation and constriction Signup and view all the answers

In managing severe asthma exacerbations, what is the recommended duration for continuing oral corticosteroids after discharge from acute care?

5 to 10 days Signup and view all the answers

What potential risk is associated with the long-term use of oral corticosteroids?

Increased risk of osteoporosis Signup and view all the answers

Which of the following adverse effects is associated with leukotriene receptor antagonists?

Eosinophilia granulomatosis with polyangiitis Signup and view all the answers

Why should oral corticosteroids be taken with food?

To prevent gastrointestinal upset Signup and view all the answers

What should patients be advised regarding the use of leukotriene receptor antagonists during an asthma attack?

They should not be used for immediate symptom relief Signup and view all the answers

In what context is it safe to use corticosteroids during pregnancy?

If needed for better asthma control Signup and view all the answers

What is a common psychiatric side effect of oral corticosteroids?

Irritability Signup and view all the answers

Which dietary consideration is important for patients taking leukotriene receptor antagonists?

Take the medicine in the evening Signup and view all the answers

Study Notes

Asthma

A chronic lung disease that can be controlled, but not cured.
Defined by variable airflow limitation and respiratory symptoms that change over time.
In young children, asthma is defined by variable respiratory symptoms as lung function testing is not feasible.
Untreated asthma is characterized by inflammation, airway hyperresponsiveness, and intermittent airway narrowing.
Asthma represents a spectrum of conditions with different pathophysiological mechanisms.
Allergic asthma is more likely when the individual has allergies and a family history of asthma.

Asthma Triggers

Viruses and bacteria
Weather
Allergens
Mold
Exercise
Smoking
Occupational exposure
Hormonal influences

Asthma Diagnosis

Diagnosis is based on history, physical examination, considering other diagnoses, documenting variable airflow limitation, and spirometry.
A diagnosis of asthma is made when:
- There's a history of variable symptoms, especially cough, chest tightness, wheeze, and shortness of breath.
- Expiratory airflow limitation has been demonstrated.
- Expiratory airflow limitation has been shown to be variable.
- There are no findings that suggest an alternative diagnosis.

Asthma Signs and Symptoms

Signs:
- Inflammation
- Airway obstruction
- Bronchial hyperresponsiveness
Symptoms:
- Wheezing
- Shortness of breath
- Chest tightness
- Cough

Spirometry

Measures air volume inhaled and exhaled over time.
Determines the effectiveness of airflow in and out of the airways.
Detects different types of lung problems.
Commonly used in asthma diagnosis.
Used to determine:
- Extent of impairment
- Response to treatment
- Outcome measures in clinical studies

Spirometry Results and Implications

Obstruction:
- FEV1/FVC ratio less than 0.75 to 0.8 for adults and less than 0.9 for children indicates airway obstruction.
- Narrow airway passage creates air turbulence and increased resistance to airflow.
Restriction:
- Limits airflow during inspiration.
- Usually caused by loss of elasticity or physical deformities of the chest.
Reversible airway obstruction:
- Can be either spontaneous or following administration of bronchodilators.

Asthma Management and Pharmacotherapy - Remember SIL

Symbicort or SABA first
ICS added as needed
LABA added as needed

Short-Acting Beta-Agonists (SABA) - Salbutamol, Terbutaline

Relax airway smooth muscle quickly.
Rapid onset of action (5 to 15 minutes).
Short duration of action (3 to 6 hours).
Similar efficacy.
Used for symptom relief in asthma and COPD and prevention of exercise-induced bronchoconstriction.

SABA Mode of Action

Stimulates beta-2 adrenoreceptors, which relaxes bronchial smooth muscle.

SABA Precautions and Adverse Reactions

Precautions:
- High or increasing SABA usage indicates poorly controlled asthma.
- Review management, check inhaler technique and compliance regularly, especially when asthma control is poor.
Adverse Reactions:
- Tremor
- Palpitations
- Headache
- Muscle cramps
- Tachycardia
- Insomnia

SABA Counseling Points

Ensure an asthma action plan is in place.
Inform doctor immediately if the medicine needs to be used in high or more frequent doses than prescribed.
Clean the inhaler mouthpiece at least once a week to prevent blockage.

Long-Acting Beta-Agonists (LABA) - Salmeterol, Fomoterol, Indacterol, Olodaterol, and Vilanterol

Relax bronchial smooth muscles for at least 12 hours.
Only used in combination with an ICS in asthma due to increased risk of asthma deaths with LABA monotherapy.
In COPD, LABAs can be used alone, in combination with SAMAs, LAMAs, or triple therapy LABA/LAMA/ICS.

LABA Mode of Action

Similar to SABA

LABA Precautions and Adverse Reactions

Precautions:
- Check inhaler technique and compliance regularly, especially when asthma is poorly controlled.
- Can be trialled in patients with ICS adverse effects or reluctance to use steroids after informed discussion with their clinician.
- Can be useful in patients with coexisting allergic rhinitis or when inhaled therapy is not practical.
Adverse Reactions:
- Tremor
- Palpitations

Leukotriene Receptor Antagonists (LTRA) - Montelukast, Zafirlukast, and Pranlukast

Block leukotrienes, which cause inflammation and constriction in the airways.
Reduce asthma symptoms and improve breathing.

LTRA Mode of Action

Inhibit the cysteinyl leukotriene receptor.

LTRA Precautions and Adverse Reactions

Precautions:
- Chewable tablets contain aspartame.
- Increased risk of neuropsychiatric adverse effects in children.
- Use in pregnancy is safe if needed for better asthma control.
- Safe to use during breastfeeding.
Adverse Reactions:
- Headache
- Abdominal pain
- Diarrhea
- Eosinophilia granulomatosis with polyangiitis (EGPA) - a rare autoimmune disease (very limited data).

LTRA Counseling Points

Take medication in the evening.
Do not use to relieve symptoms of an asthma attack. Follow the asthma action plan.
Inform doctor if there are changes in mood or behavior.
Chew chewable tablets thoroughly before swallowing.
Expect effects within days.

Oral Corticosteroids - Prednisone, Prednisolone, Dexamethasone

Anti-inflammatory action associated with glucocorticoid effects.
Rapidly reduce airway inflammation in severe asthma exacerbations.
Indicated for patients with severe exacerbations.
Start co-therapy as soon as practical, ideally within the first hour of presentation.
Continue for 5 to 10 days after discharge from acute care in adults.

Oral Corticosteroid Mode of Action

Reduces airway inflammation, which relieves symptoms of acute asthma exacerbations.

Oral Corticosteroid Precautions and Adverse Reactions

Precautions:
- Safe to use when breastfeeding.
- Avoid breastfeeding for four hours after a dose to reduce the dose to the baby.
- May reactivate latent TB.
- May increase the risk of peptic ulcer disease.
- May cause hyperglycaemia and worsen diabetes control.
- Can worsen hypertension and heart failure due to sodium and water retention.
- Intraocular pressure may increase with glaucoma.
- Long-term use increases the risk of osteoporosis.
Adverse Reactions:
- Adrenal suppression
- Sodium and water retention
- Oedema
- Hypertension
- Hypoglycemia
- Dyslipidaemia
- Psychiatric effects including euphoria, depression, and mood disturbances

Oral Corticosteroid Counseling Points

Take tablets or liquid with food to reduce stomach upset.
Medication might affect mood and cause sleeping problems. Consult with doctor for concerns.
Do not stop taking the medicine suddenly; only do so under doctor's instructions.

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Description

This quiz covers the essential aspects of asthma, including its definition, triggers, and diagnostic criteria. Learn about the chronic nature of asthma and the various factors that can exacerbate the condition. Test your knowledge on this chronic lung disease and its management.