Asthma Flashcards
Red flags for asthma in adults?
Prominent systemic features (such as myalgia, fever, and weight loss).
Unexpected clinical findings (such as crackles, finger clubbing, cyanosis, evidence of cardiac disease, monophonic wheeze, or stridor).
Persistent, non-variable breathlessness.
Chronic sputum production.
Unexplained restrictive spirometry.
Chest X-ray shadowing.
Marked blood eosinophilia
Red flags for asthma in children?
Failure to thrive.
Unexplained clinical findings (such as focal signs, abnormal voice or cry, dysphagia, and/or inspiratory stridor).
Symptoms that are present from birth.
Excessive vomiting or posseting.
Evidence of severe upper respiratory tract infection.
Persistent wet or productive cough.
A family history of unusual chest disease.
Nasal polyps
Investigations for asthma in > 17 years old patient?
FeNO (1st line)
Spirometry (2nd line)
- FEV1/FVC ratio< 70%
- FEV1 improvement by >12% after B2-agonist/steroid use
Peak Expiratory Flow (3rd line)
- >20% variability after monitoring at least twice daily for 2-4 weeks is regarded as a positive result:
Direct bronchial challenge test (4th line)
Investigations for asthma in 5 - 16 years old patient?
Spirometry (1st line)
- FEV1/FVC ratio< 70%
- FEV1 improvement by >12% after B2-agonist/steroid use
Peak Expiratory Flow (2nd line)
Treatment for asthma in adults (>16 years) [first line to last line]
SABA
SABA + ICS
SABA + ICS + montelukast
SABA + ICS + LABA
MART (ICS + fast-acting LABA) regimen + low maintenance dose ICS
Increase steroid to moderate maintenance dose
Add theophylline/anti-muscarinic/increase steroid dose to high maintenance dose
Use oral prednisolone
Treatment for asthma in adults (5 - 16 yrs) [first line to last line]
SABA SABA + ICS SABA + ICS + LRTA4 antagonist SABA + ICS + LABA SABA + MART + low dose ICS Increase ICS dose to moderate Increase ICS dose to high/add theophylline
If ICS not tolerated/contraindicated, can try: sodium cromoglicate, nedocromil sodium
Always assess inhaler technique
What delivery system used for paediatric asthma?
pMDI with spacer
What are the features of the different severities for asthma exacerbation?
Moderate: PEFR more than 50–75% best or predicted and normal speech, with no features of acute severe or life-threatening asthma.
Severe:
PEFR 33–50% best or predicted
RR > 25/minute in people over 12 years of age
RR > 30/minute in children 5 - 12 years of age
Pulse rate of at least 110/min in people over the age of 12 years, 125/min in children between the ages of 5 and 12 years
Inability to complete sentences
O2 sats of at least 92%
Life-threatening: PEFR <33% predicted Cyanosis Silent chest Confusion Poor respiratory effort Exhaustion Hypotension O2 sats < 92%
PEF variation to diagnose asthma?
20%
FEV1 improve with reversibility from B2-agonist?
15%
At what stage do you admit to hospital for the different asthma severities?
Admit all people with features of a life-threatening asthma exacerbation.
Admit people with any feature of a severe asthma attack persisting after initial bronchodilator treatment.
Admit people with a moderate asthma exacerbation with worsening symptoms despite initial bronchodilator treatment and/or who have had a previous near-fatal asthma attack –> also consider lower threshold: i.e recent admission, < 18 years
Treatment for acute asthma exacerbation?
O2 (target stats: 94 - 98%)
SABA
- nebuliser for life-threatening or severe
- MDI for moderate
Life-threatening or sever asthma:
Nebulised ipratropium
Oral steroids/IM methylprednisolone/IV hydrocortisone
