Asthma guidelines

Question 1

how to clean a spacer?

how often?

Answer 1

wash in mild detergent and allow to air dry without rinsing
wipe mouthpiece clean of detergent before using
once a month (more frequent cleaning affects the electrostatic charge)

Question 2

how often should a space be replaced?

Answer 2

6-12 months

Question 3

when are nebulised antibiotics and muclytics indicated

Answer 3

CF

Question 4

when are nebulised adrenaline or budesonide indicated

Answer 4

child with severe croup

Question 5

when is nebulised pentamidine isetionate indicated

Answer 5

prophylaxis of pneumocytis pneumonia

Question 6

when do we consider using nebs in long term treatments of asthma/COPD

Answer 6

patient remains breathless after two weeks of correctly using optimal therapy

Question 7

should a home nebuliser be used to treat acute attacks at home?

Answer 7

no - always seek help

Question 8

what proportion of nebuliser drug reaches the lungs

Answer 8

10-30%

Question 9

what size particles are needed for asthma

& pneumocitis pneumonia

Answer 9

1-5 microns for asthma (airway deposition)

1-2 microns for pnemocytis pneumonia (alveolar deposistion)

Question 10

what is the notmal diluent for nebulisers

Answer 10

NaCl 0.9%

Question 11

at what age is it recommended for children to have spacers

Answer 11

up to 5 - bronchodilators and ICS

5-15 - ICS

Question 12

parameters for sever asthma attack - can they talk?

Answer 12

cannot complete sentences in once breath

Question 13

what steroid and duration should be given for an asthma attack

and in children?

Answer 13

pred PO 5 days
child - 3 days

or
hydrocortisone IV ever 6 hours until PO pred is possible

Question 14

how does the initial treatment for asthma attack vary with severe and moderate attacks

Answer 14

severe- high flow oxygen plus SABA

moderate - SABA

Question 15

if oxygen, SABA and pred are not enough for this asthma attack what should be considered

Answer 15

• ipratropium bromide
• IV aminophylline
• magnesium sulfate

Question 16

what drug class is aminophyline

Answer 16

beta agonist

Question 17

signs of life threatening asthma attack -

O2 sats -
peak flow -

Answer 17

silent chest, feefle resp effor, cyanosis

hypotension, bradycardia, arrhythmia, exhaustion. agitation in children, reduced level of consiousness

O2

Question 18

how does treatment of life threatening asthma differ from severe asthma

Answer 18

immediately dive ipratropium bromide (in sever just give if response is poor)

Question 19

which patients are most likely to benifit from aminophylline infustion in asthma attack

Answer 19

those who have been taking theophylline

Question 20

after asthma attack when should a patient be follwed up in primary care for assessment of technique and suitable medications

Answer 20

within 48 hours

Question 21

what is step 1 of the asthma guidelines

and when should a patient be moved up to step 2

Answer 21

SABA prn

move up if needed more than twice a week

Question 22

what is step 2 of the asthma guidelines

Answer 22

standard dose ICS & SABA prn

Question 23

what is step 3 of the asthma guidelines

Answer 23

ICS/LABA & SABA prn
+/- leukotriene ag
or theophyline
or PO beta ag

Question 24

what is step 4 of the asthma guidelines

Answer 24

high dose ICS/LABA & SABA prn

if adult 6 weekly trials of one or more of:ICS/LABA & SABA prn

• leukotriene ag
• theophyline
• PO beta ag

Question 25

what is step 5 of the asthma guidelines

Answer 25

high dose ICS/LABA & SABA prn | & PO pred

Question 26

how often should stepping down the guidelines be considered

Answer 26

every 3 months

Question 27

what age child are the asthma guidelines different

Answer 27

under 5

Question 28

under 5 asthma guidelines step 1 | when to step up?

Answer 28

``` SABA prn step up if: -needed more that 2 times per week -night time symptoms more than once a week -exacerbation in last year ```

Question 29

under 5 asthma guidelines step 2

Answer 29

SABA prn | ICS or leukotriene antag

Question 30

under 5 asthma guidelines step 3 who to refer?

Answer 30

SABA prn ICS and leukotriene antag refer if under 2

Question 31

under 5 asthma guidelines step 4

Answer 31

just refer them all blimey.

Question 32

what is standard and high dose beclometasone for each age group

Answer 32

STANDARD under 12: 100-200microg BD adult: 200-400microg BD HIGH DOSE 5-12: 200-400microg BD adult: 400-1000microg BD

Question 33

what is standard and high dose fluticasone for each age group

Answer 33

STANDARD 4-12 years: 50-100microg BD adult: 50-200microg BD HIGH DOSE 5-12: 100-200microg BD adult: 200-500microg BD

Question 34

do under 5s ever get given high dose ICS

Answer 34

no

Question 35

what is standard and high dose mometasone for each age group

Answer 35

STANDARD: over 12: 400microg ON or 200microg BD HIGH DOSE over 12: 400microg BD

Question 36

broadly what is the equlivilance between beclometasone flutic and mometasone

Answer 36

fluticasone and mometasone twice as potent as beclomentasone high doses are 2x standard doses under 12s have half of dose no high doses for under 5s

Question 37

what oral drugs for asthma can be taken as normal in preg and breast feeding (2)

Answer 37

pred and theophylline

Question 38

what treatment or acute asthma attack is not suitable in pregnancy

Answer 38

parenteral beta 2 agonists

Question 39

when is measuring peak flow valuable in monitoring asthma

Answer 39

patients who are poor percievers - slow detection of deterioration