Respiratory13 UKMLA questions
Asthma — UKMLA Revision Notes
Asthma is a chronic inflammatory airway disease characterised by variable airflow obstruction, bronchial hyperresponsiveness, and airway inflammation. It presents with episodic wheeze, breathlessness, chest tightness, and cough, typically worse at night and in the early morning.
Key Facts
- Diagnosis: compatible history + objective evidence of variable airflow obstruction
- PEFR variability >20% or FEV1/FVC <70% with reversibility (≥12% increase post-bronchodilator)
- Step-up treatment: SABA → low-dose ICS → LABA + ICS → high-dose ICS + LABA + LTRA
- Acute severe asthma: PEFR 33–50% predicted, RR >25, HR >110, unable to complete sentences
- Life-threatening asthma: PEFR <33%, SpO₂ <92%, silent chest, cyanosis, exhaustion
Investigations
- Spirometry: FEV1/FVC ratio, reversibility testing
- Peak flow diary: diurnal variation >20% supports diagnosis
- FeNO: elevated in eosinophilic airway inflammation
- Skin prick tests / specific IgE: identify allergic triggers
- CXR: exclude pneumothorax in acute severe asthma
Management
- Step 1: SABA (salbutamol) PRN
- Step 2: Add low-dose ICS (beclometasone 200mcg/day)
- Step 3: Add LABA (formoterol/salmeterol) — LABA + ICS combination inhaler
- Acute severe: nebulised salbutamol + ipratropium, IV hydrocortisone, Mg sulphate if life-threatening
- Written asthma action plan for all patients
NICE Guideline: NICE NG80 — Asthma: diagnosis, monitoring and chronic asthma management (2017, updated 2021)
Related UKMLA Conditions
COPDAllergic RhinitisEczemaAnaphylaxis