Asthma

Question 1

What are the characteristics of a moderate acute asthma attack?

Answer 1

• peak flow >50%
• Able to complete full sentences
• SpO2 > 92%
• Resp rate
  less then 30 (Children 5+)
  less than 40 (Children 1-5)

Question 2

What are the characteristics of a severe acute asthma attack?

Answer 2

Peak flow between 33-50%
Unable to complete full sentences
Resp rate
- more than 25 (adult)
- more than 30 (children 5+)
- more than 40 (children 1-5)
Heart rate
- more than 125 bpm in children 5+
- more than 140 bpm in children 1-5

Question 3

What are the characteristics of a life threatening asthma attack?

Answer 3

peak flow less than 33%
SpO2 less than 92%
Cyanosis
Silent chest
Altered consciousness
Hypotension
Exhaustion

Question 4

How do you manage a moderate asthma attack in adults?

Answer 4

Home or primary care
High dose SABA via PMI and spacer
Up to 10 puffs

Hospital if inadequate response

Question 5

How do you manage a severe or life threatening asthma attack in adults?

Answer 5

Hospital immediately
High dose SABA via oxygen driven nebuliser
with or without nebulised ipratropium (bronchodilator)

Question 6

How do you manage a near fatal or life threatening with poor response to initial therapy?

Answer 6

IV aminophylline

Question 7

What should you give with all patients with an asthma attack?

Answer 7

Oral prednisolone 40mg OD for 5 days
OR IV hydrocortisone
OR IM methylprednisolone

Question 8

How do you treat hypoxaemic patients?

Answer 8

Supplementary O2 (maintain SpO2 between 94-98%)

Question 9

Why is the oxygen percentage higher for patients with asthma than COPD?

Answer 9

In COPD the carbon dioxide drives respiratory and so if the oxygen is high, then they will go into respiratory failure because they wont be getting rid of the carbon dioxide- this will turn acidic.

Question 10

How do we manage a mild to moderate asthma attack in children 2 years or over?

Answer 10

PMI and spacer- medical attention if not controlled with up to 10 puffs

Question 11

How do we manage a severe or life threatening asthma attack in children 2 years or over?

Answer 11

Hospital immediately
O2 in life threatening acute asthma or SpO2 less than 94%
First line: SABA (salbutamol) via O2 driven nebuliser

Question 12

What should all children aged over 2 be given after they have had an asthma attack?

Answer 12

3 days oral prednisolone

Question 13

What should a child aged over 2 be given if they do not respond well to a SABA?

Answer 13

Nebulised ipratropium

Question 14

If a child aged 2 years or over has poor initial response to first line treatments, what should they be given?

Answer 14

IV magnesium sulfate

Question 15

How should a child under 2 be treated for an asthma attack?

Answer 15

Hospital setting
Immediate oxygen and trial a SABA.
If needed add ipratropium bromide

Question 16

What lifestyle changes can an adult with chronic asthma make?

Answer 16

Weight loss in overweight patients
Smoking cessation
Breathing exercise programme

Question 17

What are the steps for chronic asthma management in adults?

Answer 17

Step 1: Intermittent reliever (SABA)
e.g. salbutamol

Step 2: SABA and Low dose regular preventer (ICS)

Step 3: SABA and ICS and
NICE recommends LTRA e.g. montelukast
BTS/SIGN recommends LABA
Fixed dose or as MART
e.g. Fostair or symbicort

Step 4: Add LABA if not already added
Can be given with or without LTRA
can convert fixed dose LABA and mod strength ICS into MART.

Step 5: Specialist only
High strength ICS or Theophylline, Tiotropium, Oral corticosteroids, Monoclonal antibodies

Question 18

What are the steps for chronic asthma management in children over 5?

Answer 18

Step 1: Intermittent reliever (SABA)
e.g. salbutamol

Step 2: SABA and very low dose regular preventer (ICS)

Step 3: SABA and ICS and
NICE recommends LTRA e.g. montelukast
BTS/SIGN recommends LABA (if 12+)

Step 4: Replace LTRA with LABA if not already on one
Can be given as MART if still no change

Step 5: Specialist
Increase ICS strength or initiate:
Oral corticosteroids
Theophylline
Monoclonal antibodies
Tiotropium (12+)

Question 19

What are the steps for chronic asthma management in children under 5?

Answer 19

Step 1: Intermittent reliever (SABA)
if using more than one device a month then urgent referral is needed.

Step 2: SABA and regular preventer (ICS) at very low strength
Trial for 8 weeks to see if works before continuing

Step 3: SABA + ICS + LTRA
if still not controlled then stop LTRA and refer to specialist

Question 20

What is an adult low dose ICS?

Answer 20

Clenil 100
2 puffs BD so 400mcg a day

Question 21

What is a paediatric dose of ICS?

Answer 21

Clenil 50
2 puffs BD so 200mcg a day

Question 22

What must be considered when dropping down doses of asthma treatment?

Answer 22

Must be controlled for at least 3 months
Patients should be regularly reviewed when decreasing treatment
Patients should be maintained at the lowest possible dose of ICS- reductions considered every 3 months at 25-50% reduction.

Question 23

What are the signs of complete control os asthma?

Answer 23

No daytime symptoms
No night time awakening due to asthma
No asthma attacks
No need for rescue medication
No limitations on activity including exercise
Normal lung function (FEV1 +1 or PEF >80% of predicted or best)
Minimal side effects from treatment