asthma

Question 1

risk factors for asthma?

Answer 1

personal / FHx of atopy

• antenatal (maternal smoking, RSV infection in pregnancy)
• LBW
• bottle-fed
• second-hand smoke
• exposure to high concentrations of allergens
• air pollution
• “hygiene hypothesis” in developed countries

Question 2

features of asthma?

Answer 2

• cough, worse at night
• dyspnoea
• expiratory wheeze on auscultation
• chest tightness
• nasal polyps
• reduced PEFR

Question 3

finding in occupational asthma?

Answer 3

• reduced peak flow readings at work

- normal rest of the time

Question 4

investigation findings in asthma?

Answer 4

• spirometry
• FEV1 (significantly reduced)
• FVC (normal)
• FEV1/FVC <70%
• fractional exhaled nitric oxide (FeNO)

Question 5

first line treatment in asthma?

Answer 5

• SABA (e.g. salbutamol)
• blue inhaler, “reliever”
• relaxes smooth muscle in airways
• SE: tremor

Question 6

second line treatment in asthma?

Answer 6

• inhaled corticosteroids (e.g. beclometasone)
• brown inhaler, “preventer”
• taken every day regardless of symptoms
• SE: thrush, stunted growth

Question 7

third line treatment in asthma?

Answer 7

• LABA (e.g. salmeterol)

- taken every day regardless of symptoms

Question 8

fourth line treatment in asthma?

Answer 8

leukotriene receptor antagonists (e.g. monteleukast)

Question 9

what is maintenance and reliever therapy?

Answer 9

• ICS + LABA

- used for poorly controlled asthma

Question 10

first step in asthma treatment for kids?

Answer 10

SABA alone

Question 11

second step in asthma treatment for kids?

Answer 11

• SABA

- low-dose ICS

Question 12

in which scenario would the second step of the asthma treatment for kids be used FIRST?

Answer 12

newly-diagnosed asthma with:

• > 2 symptoms / week OR
• night-time waking

Question 13

third step in asthma treatment for kids?

Answer 13

• SABA
• low-dose ICS
• LTRA

Question 14

fourth step in asthma treatment for kids?

Answer 14

• SABA
• low-dose ICS
• LABA (swapped from LTRA)

Question 15

fifth step in asthma treatment for kids?

Answer 15

• SABA

- MART

Question 16

sixth step in asthma treatment for kids?

Answer 16

• SABA

- moderated-dose ICS MART

Question 17

seventh step in asthma treatment for kids?

Answer 17

SABA + 1 of:

• high-dose ICS
• theophylline
• advice from asthma specialist

Question 18

first step in asthma treatment for <5s?

Answer 18

SABA

Question 19

second step in asthma treatment for <5s?

Answer 19

• SABA

- 8 week trial of mod-dose ICS

Question 20

third step in asthma treatment for <5s?

Answer 20

• SABA
• low-dose ICS
• LTRA

Question 21

fourth step in asthma treatment for <5s?

Answer 21

• cont SABA
• cont low-dose ICS
• stop LTRA and refer to specialist

Question 22

what is a low-dose of ICS for children?

Answer 22

<200 micrograms of budesonide

Question 23

what is a medium-dose of ICS for children?

Answer 23

200-400 micrograms of budesonide

Question 24

what is a high-dose of ICS for children?

Answer 24

> 400 micrograms of budesonide

Question 25

signs of a moderate asthma attack in 2-5 year olds?

Answer 25

- SpO" >92% | - no features of severe asthma

Question 26

signs of a severe asthma attack in 2-5 year olds?

Answer 26

- SpO2 <92% - too breathless to feed/talk - HR >140/min - RR >40/min - use of accessory neck muscles

Question 27

signs of a life-threatening asthma attack in 2-5 year olds?

Answer 27

- SpO2 <92% - silent chest - poor respiratory effort - agitation - altered LOC - cyanosis

Question 28

what must be checked in all children >5 years of age in an acute asthma attack?

Answer 28

PEF

Question 29

signs of a moderate asthma attack in children >5 years old?

Answer 29

- SpO2 >92% - PEF >50% of prediction - no features of severe asthma

Question 30

signs of a severe asthma attack in children >5 years old?

Answer 30

- SpO2 <92% - PEF: 33-50% - can't complete sentences in 1 breath - HR >125/min - RR >30/min - use of accessory neck muscles

Question 31

signs of a life-threatening asthma attack in children >5 years olds?

Answer 31

- SpO2 <92% - PEF <33% predicted - silent chest - poor respiratory effort - altered LOC - cyanosis