Asthma

Question 1

What is the pathophysiology of asthma

Answer 1

bronchial inflammation -> bronchial hyperresponsiveness -> airway narrowing -> sx

Question 2

What are the key features of asthma hx?

Answer 2

1. Diurnal variation - sx worse at night and early in morning
2. Sx w triggers
3. Interval sx
4. PMH/FHx of atopy
5. +ve response to asthma therapy

Question 3

What are clinical features suggestive of asthma?

Answer 3

Hyperinflation
Wheeze
Atopy - allergic rhinitis, eczema
Harrisons sulcus

Question 4

What are the classical sx

Answer 4

Wheeze
Cough
SOB
Chest tightness

Question 5

What are triggers of asthma?

Answer 5

infections 
allergens 
exercise
cold air
emotion/laughter (children)

Question 6

What is complete control of asthma defined as?

Answer 6

no daytime sx
no night time waking 
no need for rescue meds
no asthma attacks 
no limits on activity
normal lung function (FEV1 and/or PEF >80% predicted or best
min. SEs from meds

Question 7

Give the pharmacological management of asthma in adults

Answer 7

1. SABA + low dose ICS
2. • LABA (fixed dose or MART)
3. • med dose ICS or LTRA, consider stopping LABA

Question 8

What is the reliever therapy?

Answer 8

inhaled SABA - salbutamol

Question 9

What are the common ICS?

Answer 9

beclometasone
budesonide
fluticasone

Question 10

How does smoking affect use of ICS?

Answer 10

reduces effectiveness so require higher doses

Question 11

What does LTRA stand fro

Answer 11

leukotriene receptor antagonists

Question 12

Give examples of LABAs

Answer 12

formoterol

salmeterol

Question 13

what is MART

Answer 13

Maintenance and reliever therapy

Question 14

Give the pharmacological management of asthma in children ≥5yrs

Answer 14

W1. SABA + ICS (v low dose)
2. + LABA or LRTA 
3. + ↑ ICS to low dose 
or 
\+ LABA or LRTA 
If no response to LABA, consider stopping

Question 15

What is the management of asthma in children <5yrs?

Answer 15

1. SABA + ICS

2. + LTRA

Question 16

What peak flow values suggest acute asthma that is

i. moderate
ii. severe
iii. life threatening

Answer 16

i. >50-75%
ii. 33-50
iii. <33
of best or predicted

Question 17

What are the features of mod acute asthma

Answer 17

increasing sx

no features of acute severe asthma

Question 18

What are the features of acute severe asthma

Answer 18

RR ≥25
HR ≥ 11
inability to complete sentences in one breath

Question 19

What are the features of life-threatening asthma

Answer 19

SpO2 <92
PaO2 <8 kPa
'normal' PaCO2 
Altered conscious 
Exhaustion
Arrhythmia
Hypotension
Cyanosis
Silent chest 
Poor response effort

Question 20

What are the features of near fatal asthma

Answer 20

raised PaCO2 and/or requiring mechanical ventilation w raised inflation pressures

Question 21

What is the treatment of acute asthma

Answer 21

1. O2 - maintain sats 94-98
2. Salbutamol 5mg nebulised w O2
3. Pred 40-50mg PO or hydrocortisone 100mg IV
4. Ipratropium 0.5mg 4-6hr
5. Consider magnesium sulphate 1.2-2g IV over 20mins if no good response to initial therapy
   REASSES EVERY 15 MINS, REPEAT SALB EVERY 15-30mins or 10mg/hr

Question 22

What is the treatment of acute asthma that improves w/in 15-30m

Answer 22

Continue neb salb every 4-6hrs (+ ipratropium if started in prev step)
Pred 40-50mg PO OD for 5-7 days

Question 23

What is the treatment of acute asthma in children?

Answer 23

SABA -> oral prednisolone -> neb ipratropium bromide -> IV hydrocortisone -> repeat bronchodilators every 20-30min -> IV salbutamol/theophylline -> IV magnesium sulphate