Asthma (Chronic)

Question 1

PEF meaning

Answer 1

Peak expiratory force- Peak expired force during one breath

Question 2

FEV1 meaning

Answer 2

Forced expiratory volume= volume of air that can be forcebly expired in 1 second

Question 3

Symptoms of asthma

Answer 3

Chest tightness
SOB
Cough
Wheeze

Question 4

Symptom of asthma that is a risk factor for acute exacerbations

Answer 4

Night time wakening

Question 5

Definition of uncontrolled asthma

Answer 5

Frequent regular symptoms (night-time wakening on 1+ nights a week or 3+ days using reliever therapy) OR exacerbation requiring a course of corticosteroids

Question 6

First assessment for asthma diagnosis

Answer 6

Blood eosinophils or FeNO

Question 7

Value for FeNO required for diagnosis of asthma

Answer 7

> 50ppb

Question 8

2nd option for diagnosis of asthma if diagnosis cannot be made

Answer 8

Bronchodilator reversibility with spirometry

Question 9

What does the FEV1 need to be in order to get a diagnosis of asthma from bronchodilator reversibility?

Answer 9

FEV1 of >12% or >200ml increase after bronchodilator OR FEV1 increase of >10% of predicted

Question 10

If there is a delay or BDR cannot be done for the diagnosis of asthma, what test can be done?

Answer 10

Peak expiratory flow variability BD for 2/52

Question 11

If a diagnosis of asthma cannot be made using the first 3 assessments, what is recommended?

Answer 11

Bronchial challenge test

Question 12

What assessment should not routinely be used for asthma monitoring?

Answer 12

PEF variability

Question 13

What assessments should be completed as part of regular asthma reviews and upon change in therapy?

Answer 13

FeNO + validated symptom questionaires

Question 14

Whne should response be checked after starting/ adjusting therapy for asthma?

Answer 14

8-12 weeks

Question 15

What should be considered for <12 years old with asthma if they have a DPI?

Answer 15

Seperate MDI + spacer for emergency use in asthma in case they don’t have the inhalation force for a DPI

Question 16

What should choice of inhalers be based upon?

Answer 16

Patient preference, presence of integral dose counter, therapy with the least environmental impact, and assessment of correct inhaler technique

Question 17

Should SABAs be prescribed alone in asthma treatment?

Answer 17

NO- must have concomittant ICS alongside

Question 18

1st line for asthma treatment in >12 years

Answer 18

AIR therapy (ICS + formoterol combination inhaler) used prn

Question 19

What is 1st line therapy in asthma if the patient is severely symptomatic or experiencing night-time wakening?

Answer 19

Low-dose MART (AIR therapy should be skipped until well enough to step-down)

Question 20

2nd line treatment for asthma in >12 years

Answer 20

Low-dose MART therapy

Question 21

Step-up if patient is on Low-dose MART with uncontrolled asthma?

Answer 21

Medium-dose MART

Question 22

3rd line treatment for asthma >12 years.

Answer 22

Check FeNO and eosinophils.
- If not raised: Moderate-dose MART + LTRA/LAMA
- If raised: specialist referral

Question 23

Patient uncontrolled asthma with moderate-dose MART and LTRA, next step in therapy?

Answer 23

Stop LTRA, continue medium-dose MART and add LAMA

Question 24

Patient experiencing some control (but not uncontrolled) with moderate-dose MART and LTRA, next step in therapy?

Answer 24

Add on LAMA

Question 25

According to new guidelines, what should a patient on just a SABA be converted to if asthma is uncontrolled?

Answer 25

AIR therapy prn

Question 26

What constinuents are in a MART inhaler?

Answer 26

ICS/ formoterol

Question 27

What constinuents are in an inhaler used for AIR therapy?

Answer 27

ICS/ formoterol

Question 28

According to new guidelines, what should a patient on inhaler therapy that includes a LAMA, experiencing uncontrolled asthma, be converted to?

Answer 28

Moderate-dose MART

Question 29

According to new guidelines, what should a patient on inhaler therapy that includes a moderate-dose ICS, experiencing uncontrolled asthma, be converted to?

Answer 29

Moderate-dose MART

Question 30

How should a patient presenting with uncontrolled asthma, on a high-dose ICS, be managed?

Answer 30

Specialist referral

Question 31

Which asthma drug has a common side effect of upper respiratory tract infections?

Answer 31

Montelukast

Question 32

Which drug class used in asthma is asscociated with neuropsychiatric reactions?

Answer 32

Leaukatriene receptor antagonists (LTRA)

Question 33

Why is formoterol the chosen LABA for AIR/MART therapy?

Answer 33

Same onset of action as SABA, but longer duration of action

Question 34

Side effects of ICS therapy?

Answer 34

Sore throat, oral thrush, cough, hoarseness

Question 35

Side effects of LABA/ SABA?

Answer 35

Hyperkalaemia, tremor, insomnia, sweating, agitation, tachycardia, palpitations

Question 36

How often should a spacer be cleaned and how?

Answer 36

Cleaned once monthly with mild soapy water and air dry

Question 37

How often should a spacer be replaced?

Answer 37

Every 6-12 months