Asthma

Question 1

What is asthma?

Answer 1

Asthma is a chronic respiratory condition usually associated with airway inflammation and hyper-responsiveness

Question 2

What are the risk factors for asthma?

Answer 2

FH/personal history of atopy - asthma, eczema and allergic rhinitis
Obesity
Allergen exposure
Occupational exposure
URTI
Drugs such as NSAIDs, aspirin, beta blockers

Question 3

Symtpoms of asthma

Answer 3

Cough
Wheeze
Chest tightness
SOB
Worse at night/on waking/seasonal

Question 4

How do you make a diagnosis of asthma?

Answer 4

• Measure the blood eosinophil count (higher than reference range) or FeNO (>50 is asthma) in adults with a history suggestive of asthma
• If FeNO or eosinophil count does not confirm asthma -> use spirometry with reversibility:
  Diagnose asthma if the FEV1 increase is 12% or more and 200 mL or more from the pre-bronchodilator measurement
• If spirometry is not available- PEFR for 2 weeks

Question 5

Management of asthma: 1st Line

Answer 5

1) AIR therapy (anti-inflammatory reliever) - low dose ICS/LABA (currently formoterol) to use as needed

Question 6

2nd line

Answer 6

2) If still highly symptomatic/night time waking/using AIR >3x a week - use low-dose MART (ICS/formoterol)
3) If low dose doesn’t work then use moderate dose

Question 7

3rd line

Answer 7

If moderate dose MART doesn’t work:
Measure FeNO and eosinophil if either is raised - refer to specialist

If neither is raised offer leukotriene receptor antagonist (LTRA) e.g Montelukast or LAMA e.g. tiotropium in addition to MART for 8-12 weeks

If one doesn’t work use the other i.e. LRTA or LAMA

Question 8

What are the levels of severity of asthma exacerbation?

Answer 8

Life-threatening:
Adults and children with cyanosis, drowsy, exhaustion, poor respiratory effort, confusion (may be a sign of hypoxia), O2 <92%, hypotension, PEF <33%, and/or ‘silent chest’.

Acute severe
Adults: Inability to complete sentences in one breath, O2 <92%, RR >25, pulse >110, and PEF 33–50% best or predicted.
Children: too breathless to talk or feed; use of accessory neck muscles, O2 <92%, PEF 33–50% best or predicted

Moderate
Talking in sentences, prefers sitting to lying, O2 <92% or more; PEF >50% best or predicted

Question 9

Management of acute exacerbation of asthma

Answer 9

Give O2
Nebulised SABA and ipratropium bromide (SAMA)
Oral prednisolone