Asthma

Question 1

What is the stepwise management in Asthma

Answer 1

Step 1: SABA
Step 2: SABA + ICS (low dose)
Step 3: SABA + ICS + Leukotriene receptor antagonist e.g. montelukast
Step 4: SABA + ICS + LABA (continue leukotriene antagonist depending on patients response)
Step 5: SABA +/- a LRTA and change ICS and LABA regime to a maintenance and reliever therapy (MART) - includes a low dose ICS
Step 6: SABA +/- LTRA + medium-dose ICS MART
OR consider changing back to a fixed-dose of a moderate-dose ICS and a separate LABA
Step 7: SABA +/- LRTA increase dose of ICS (not as part of MART)
trial other drugs such as theophylline (long acting muscarinic receptor antagonist)

Question 2

What are the signs of life threatening asthma?

Answer 2

Silent chest 
Confusion 
Exhaustion 
Cyanosis 
Bradycardia 
PEF <33% predicted

Question 3

What is the difference between life threatening and near fatal asthma?

Answer 3

in near fatal asthma there is raised pCO2 as well as low o2 - type 2 respiratory failure

Question 4

Which investigations are done in chronic asthma?

Answer 4

Peak flow home monitoring
Spirometry - shows obstructive defecit, reduced FEV1/FVC (<70%) WITH REVERSIBILITY
Bronchodilator given and FEV1 shows >15% improvement
Skin prick tests may identify allergens

Question 5

Which investigations are done in an acute attack?

Answer 5

Peak flows, o2 sats, BP, HR, RR
sputum cultures 
Bloods: FBC, U+Es, CRP 
Blood culture 
ABG - usually normal or slightly low pO2 and decreased PCO2 from hyperventilation

Question 6

How is acute severe asthma managed?

Answer 6

1. Oxygen
2. Nebulised salbutamol 5mg with oxygen,
3. Prednisolone 30mg PO or hydrocortisone 100mg IV
4. Inform seniors
5. Monitor sats, HR and RR> monitor ECG - watch or arrhythmias
6. ABG
   If life threatening features present
   - inform seniors and ICU
   - Salbutamol nebs every 15 mins or 10mg continuously - monitor ECG
   - Ipratropium bromide 0.5mg to nebs
   - Give single dose of MgSO4 1.2-2g IV over 20 mins

Question 7

How is life threatening asthma managed?

Answer 7

Inform ICU and seniors
Give nebs every 15 mins or 10mg continuously
add ipratropium bromide 0.5mg 4-6hourly
Give single dose of Magnesium sulfate 1.2-2g IV over 20 mins

Question 8

What can be done in airway compromise

Answer 8

Chin lift
Jaw thrust
insert an oropharyngeal (guedel) if unconscious
if partially conscious then insert nasopharyngeal airway

Question 9

What are the signs of acute asthma?

Answer 9

Tachypneoa 
Reduced air entry 
Audible polyphonic wheeze
Hyperinflation 
Moderate - able to complete sentences 
Severe attack - unable to complete sentences

Question 10

What other conditions are associated with asthma?

Answer 10

hayfever
ezcema
allergies

Question 11

What are the features of a severe asthma attack?

Answer 11

Unable to complete sentences
Resp rate >25/min
HR >110/min
PEFR 33-50% of predicted or best

Question 12

If a patient with a severe asthma attack begins to improve how does their treatment change

Answer 12

Salbutamol every 4hrs
Prednisolone 40-50mg PO OD for 5-7 days
Monitor peak flow and O2 sats, aim for 94-98% with supplemental if needed

Question 13

What is asthma

Answer 13

Chronic inflammtory airways obstruction with reversibility with increased airway responsiveness to stimuli e.g. dustmites leading to bronchoconstriction

Question 14

What are the signs in a Moderate asthma attack?

Answer 14

PEFR 50-75%
Pulse <110
RR <25
Speech normal