Asthma

Respiratory (12%) Core Clinical Conditions

1A: Able to diagnose and manage

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Definition Aetiology Pathophysiology Risk factor Sign and Symptoms Investigations Management

Definition

Asthma is a chronic respiratory disease that affects the lungs' airways. Coughing, wheezing, shortness of breath, and chest tightness are common symptoms.

Aetiology

Genetic predisposition & family history.
Environmental factors: allergens, irritants, pollution and respiratory infections.
Obesity.

Pathophysiology

Inflammatory response: airways are inflamed when exposed to triggers such as allergens, irritants or respiratory infections.
Narrowing of airways: inflammation > smooth muscles of airways constriction > symptoms of breathlessness, wheezing and sneezing.
Excess mucus production = more obstruction of airways.
Airway remodelling: longstanding inflammation > permanent change to structure of airways > worsening of asthma.

Risk factors

Genetics.
Individuals with allergies e.g hayfever.
Environmental exposures: smoking, air pollution, irritants etc.
Respiratory infections in early childhood may increase risk of developing asthma.
Obesity.
Gender: females are likely to have asthma when compared to males.
Age: younger individuals are likely to have asthma than adults.
Ethnicity: some ethnic groups are more at risk than others e.g. Africans or Hispanics.

Sign and symptoms

Wheezing, shortness of breath (SOB), chest tightness, coughing, rapid breathing and fatigue.

Diagnosis and investigations

Spirometry
Peak flow measurement.
Chest X-ray.
FeNO testing: A breath test that analyses the amount of nitric oxide in the breath. If the levels are elevated, it is likely that the patient has asthma.

Management

The following guideline is for adults over the age of 17:

Step 1: If an individual has mild asthma, they should use a short-acting inhaler (SABA) like Salbutamol when needed for relief.
Step 2: If asthma is still not controlled, a low-dose inhaled corticosteroid (ICS) like Clenil can be added, and the person should continue using the SABA as needed.
Step 3: If asthma remains uncontrolled, the addition of a leukotriene receptor antagonist (LTRA) medication called Montelukast is recommended, and progress should be reviewed in 4 weeks.
Step 4: If asthma continues to be uncontrolled, a long-acting inhaler (LABA) like Salmeterol can be added.
If the above steps fail: The recommendation is to switch to a combination inhaler with both ICS and LABA, such as Fostair.
If there is no response to LABA: The individual should stop using it and seek consultation with a specialist for further care.