Asthma Management (Children and Adults)

Question 1

Describe non-pharmacological clinical management of asthma

Answer 1

• Patient education and self-management plans
• Exercise
• Smoking cessation
• Weight management
• Flu/pneumococcal vaccinations

Question 2

Outline the stepwise approach to management of asthma based on the Scottish Intercollegiate Guidelines Network (SIGN) and British Thoracic Society (BTS) Guidelines

Answer 2

Step 1;
- Very low dose ICS
Step 2;
- Very low dose ICS 
- >5 y.o. LABA, <5 y.o. LRTA
Step 3;
- No response to LABA: stop LABA, increase ICS to low dose
- Inadequate response to LABA: continue LABA, increase ICS to low dose, consider trial of LRTA
Step 4;
- Trial increasing ICS to medium dose
- Trial adding theophylline
- Refer to specialist!
Step 5;
- Add daily oral steroid
- Maintain medium dose ICS
- Consider other treatments to minimise steroid use

Question 3

How do you measure control of asthma in a child?

Answer 3

SANE

• SABA/week
• Absence from nursery/school
• Nocturnal symptoms/week
• Exertional symptoms/week

Question 4

Name the different types of inhalers

Answer 4

• Metered dose inhaler (pMDI)
• pMDI with spacers
• Dry powder inhalers (DPI)

Question 5

What are the differences in the treatment of asthma in children?

Answer 5

• ICS max. dose <12 y.o. = 800mg
• No oral LABA
• LRTA in <5 y.o.
• No LAMA

Question 6

What are the adverse effects of ICS?

Answer 6

• Height suppression
• Oral candidiasis
• Adrenocortical suppression

Question 7

What are the adverse effects of ICS?

Answer 7

• Height suppression
• Oral candidiasis
• Adrenocortical suppression
• Hypertension
• Cataracts

Question 8

What two things must you remember about LABA?

Answer 8

• Do not use without ICS

- Use as a fixed dose inhaler

Question 9

MDI spacer vs nebuliser

Answer 9

• Cheaper
• Portable
• Quieter
• Quicker
• Valve mechanism
• Don’t break down

Question 10

Steroid in chronic vs acute asthma

Answer 10

Acute - oral

Chronic - inhaled