Asthma

Question 1

What percentage of asthma attacks are preceded by an increase in symptoms for at least 48 hours?

Answer 1

80%

Question 2

If a reliever is used 3 times in one week, what action is needed?

Answer 2

Need r/v

Question 3

What indicates the need for urgent r/v regarding a reliever?

Answer 3

If reliever isn’t lasting 4 hours

Question 4

What is the recommended testing sequence for patients aged 5-16?

Answer 4

FeNo—>Spirometry and BDR → peak flow—> Skin prick or total IgE and blood eosinophils

Question 5

What is the recommended testing sequence for patients aged 16 and older?

Answer 5

FeNo or eosinophils → Spirometry + BDR → Peak flow—> Bronchial challenge testing

Question 6

Should FeNo testing be used for diagnosis or monitoring?

Answer 6

Diagnosis

Question 7

What FeNo level indicates a diagnostic result in adults?

Answer 7

> 40

Question 8

What FeNo level indicates a diagnostic result in children aged 5-16?

Answer 8

> 35

Question 9

What is the effect of smoking on FeNO levels?

Answer 9

Reduces FeNO

Question 10

What spirometry result indicates obstruction?

Answer 10

FEV1/FVC <0.7

Question 11

What is the criterion for reversibility in asthma testing?

Answer 11

Increase in FEV1 of >12% predicted or 200mls

Question 12

What objective test should you do on <5

Answer 12

ITS A TRAP. Not usually possible. Diagnosis on clinical suspicion, test of treatment (using low ICS) and regular r/v

Question 13

what are you two options for treatment regimes?

Answer 13

Air - anti inflammatory reliever
Mart - maintenance and reliever therapy

Question 14

What do you offer first - air or Mart

Answer 14

Air (offer mart is highly symptomatic or severe exacerbations)

Question 15

Is asthma is uncontrolled despite food adherence on moderate dose MART what should you do?

Answer 15

Check FeNO level and blood eosinophil count ( if neither raised can consider a trail of LTRA or LAMA in addition to moderate dose MART for 8-12 weeks )

Question 16

Newly diagnosed asthma in 5-11 what do you start?

Answer 16

Low dose ICS with SABA

Question 17

If asthma uncontrolled in 5-11year old on 1st line what do you do next?

Answer 17

Assess suitability for MART

Question 18

5-11 MART not suitable what next?

Answer 18

Add LTRA to BD ICS for trial 8-12 weeks

Question 19

If the LTRA + ICS is unsuccessful in 5-11year old with asthma still uncontrolled what next?

Answer 19

BD low dose ICSA/LABA +- LTRA (if still uncontrolled then increase to moderate dose)

Question 20

In under 5 with suspected asthma what treatment?

Answer 20

8-12 week trial of BD low dose ICS with SABA (after this consider stopping and r/v in 3months)

Question 21

What are 4 symptoms of asthma

Answer 21

Wheeze
breathlessness
chest tightness
Cough

Question 22

What is the first line antibiotic in cough?

Answer 22

Doxy (reserve amid for pneumonia)

Question 23

When can you not give doxy (and what do you give instead)

Answer 23

If breastfeeding/pregnant (give Amox or erythromycin if macrolide needed)

Question 24

If point of care CRP for cough what are the cut offs for AB

Answer 24

<20 not routine AB
20-100 consider delayed script
100+ offer AB

Question 25

CRB65 what does it stand for

Answer 25

Confusion <8/10 RR >30 BP sys <90 or dia <60 >65 years of age

Question 26

What should be given only if there is evidence of infection in acute asthma management?

Answer 26

Antibiotics ## Footnote Antibiotics are not routinely given in acute asthma unless an infection is confirmed.

Question 27

Name two factors leading to poor outcomes in asthma management.

Answer 27

* Patients not recognising severity * Clinicians not assessing severity objectively * Underuse of corticosteroids

Question 28

What is the PEFR range for moderate acute asthma?

Answer 28

PEFR >50-75% best/predicted ## Footnote PEFR stands for Peak Expiratory Flow Rate.

Question 29

What are the vital sign criteria for severe acute asthma?

Answer 29

* Sats ≥92% * PEFR 33-50% best/predicted * Can't finish a sentence in 1 breath * RR ≥25 * P ≥110

Question 30

What is the recommended oxygen saturation target for severe acute asthma?

Answer 30

94-98% ## Footnote Oxygen should be administered to maintain this saturation level.

Question 31

What defines life-threatening asthma?

Answer 31

* PEFR <33% best/predicted * Sats <92% or cyanosis * Feeble respiratory effort/silent chest * Hypotension/arrhythmia * Exhaustion/altered consciousness

Question 32

What is the maximum dose of Salbutamol that can be administered via spacer?

Answer 32

10 puffs ## Footnote Salbutamol can also be given nebulised at 5mg.

Question 33

What is the recommended oral Prednisolone dosage for acute asthma?

Answer 33

40-50mg for at least 5 days or until recovery

Question 34

When should you have a lower threshold to admit a patient with acute asthma?

Answer 34

* Recent admission * Afternoon/evening attack * Patient unable to assess own symptoms * Recent nocturnal symptoms * Concern over social situation

Question 35

What should be checked during primary care follow-up after asthma discharge?

Answer 35

* Symptoms and peak flow * Inhaler technique * Understanding of inhalers

Question 36

True or False: Most patients with improving asthma can go home after treatment.

Answer 36

True

Question 37

Fill in the blank: _______ should be provided to patients to help manage their asthma post-discharge.

Answer 37

Written PAAP

Question 38

What should be addressed to prevent future admissions after an asthma episode?

Answer 38

Potentially preventable contributors to admission

Question 39

What is the protocol for patients with a history of near-fatal asthma after initial treatment?

Answer 39

Admit immediately

Question 40

How soon following discharge from hospital with asthma attach should there be follow up

Answer 40

48h

Question 41

When do you use ipratropium neb in asthma?

Answer 41

When life threatening (alongside salbutamol)

Question 42

You should use percentage of best PEFR in preference to percentage predicted PEFR if possible TRUE OR FLASE

Answer 42

True

Question 43

What is the salbutamol and ipratropium dose in an adult

Answer 43

Salbutamol 5mg, ipratropium 0.5mg

Question 44

What is the ipratropium dose in a child?

Answer 44

0.25mg (regardless of age)

Question 45

What is the salbutamol dose in a child (nebuliser)

Answer 45

2-5 2.5mg 5+ 5mg (same as adult)

Question 46

What are the prednisone doses in asthma for all ages

Answer 46

<2 10mg 2-5 20mg 5+ 30-40mg Adult 40-50mg