Obstructive airway disease

Question 1

what is a common chronic inflammatory condition of the airways associated with airway hyperesponsiveness and variable airflow obstruction

Answer 1

Asthma

Question 2

Symptoms of asthma

Answer 2

cough, wheeze, chest tightness, breathlesness

Question 3

What is the name of the syndrom that has both asthma and COPD features?

Answer 3

Asthma-copd overlap syndrome (ACOS)

Question 4

What is defined as complete control of asthma?

Answer 4

No daytime symptoms, no night time wakening, no asthma attacks, no need for rescue medication, no limitations during exercise, FEV1 of >80%

Question 5

What lifestyle changes can help with asthma symptoms?

Answer 5

1. weight loss
2. smoking cessation
3. breathing exercise programmes

Question 6

Before initiating a new asthma drug what should be checked?

Answer 6

Inhaler technique, adherence, eliminate triggers

Question 7

FEV1

Answer 7

the amount of air a person can forcefully exhale in one second

Question 8

FVC

Answer 8

the total amount of air exhaled in one breath

Question 9

First line medication for Asthma in patients age 17 and over

Answer 9

SABA ( salbutamol, terbutaline)

Question 10

How frequently must a patient be using their SABA before they need urgent assessment?

Answer 10

If going through >1 inhaler a month

Question 11

What features warant starting ICS therapy?

Answer 11

1. using a SABA three times a week
2. symptomatic three times a week
3. waking a night due to asthma symptoms at least weekly
4. Had an asthma attack in the last 2 years

Question 12

At what frequency do SIGN/BTS suggest ICS should be administered initially?

Answer 12

BD

Question 13

True or false - BTS/SIGN recommend prescribing inhalers by brand?

Answer 13

True

Question 14

If asthma is uncontrolled on ICS + SABA what is the initial add on therapy?

Answer 14

Leukotriene receptor antagonist e.g. Montelukast and review responce in 4 - 8 weeks

Question 15

what is third line asthma therapy for NICE guidelines?

Answer 15

ICS + LABA (with or without LRTA)

Question 16

Whast is the forth line for asthma therapy according to NICE?

Answer 16

MART

Question 17

What is MART ?

Answer 17

Maintenance and reliever therapy - one combination inhaler

Question 18

Examples of MART inhalers?

Answer 18

Symbicort
Fostair
DuoResp Spiromax
Fobumix Easyhaler

Question 19

If MART does not work, what are the other options?

Answer 19

1. Increase ICS + LABA + LRTA or increase ICS and continue MART
2. High ICS / theophylline / LAMA –> refer

Question 20

Examples of monoclonal antibodies that can be used for asthma?

Answer 20

Omalizumab, mepolizumab. benralizumab, reslizumab

Question 21

How long should you trial ICS in a child <5 years if they have symptoms to suggest its use?

Answer 21

8 weeks

Question 22

When should you consider reducing the maintenance dose of asthma treatment?

Answer 22

When symptoms are well controlled for at least 3 months

Question 23

What dose of ICS should patient’s be maintained on?

Answer 23

The lowest possible dose

Question 24

What is the drug of choice for exercised induced asthma?

Answer 24

SABA

Question 25

What marks an acute asthma exacerbation?

Answer 25

reduction in baseline measures of pulmonary function e.g. FEV1 and peak flow

Question 26

What are the features of moderate acute asthma?

Answer 26

Peak flow >50-75% best or predicted, no features of acute severe asthma

Question 27

what are the features of severe acute asthma?

Answer 27

Peak flow 33-50% best or predicted, RR >25, HR>110, inability to speak sentences in one breath

Question 28

What are the features of life threatening acute asthma?

Answer 28

Peak flow <33% best or predicted, SpO2 <92%, PaO2<8kPa, normal PaCo2, cyanosis, silent chest, arrhythmia, exhaustion, hypotension

Question 29

What is a feauture of near-fatal acute asthma?

Answer 29

Raised PCo2 and/or the need for mechanical ventiliation with raised inflation pressures

Question 30

What types of asthma need to be admitted to hospital?

Answer 30

Severe or life threatening cases

Question 31

What is the O2 sat aim for an asthma patient?

Answer 31

94-98%

Question 32

Treatment for acute asthma exacerbation

Answer 32

1. High dose LABA ( potentially nebulised or given IV if cannot have inhaled therapy) 2. Prednisolone 40mg PO 5 days minimum (or IV methylpred/hydrocortisone) 3. Magnesium sulfate 1.2 -2g infusion / Aminophylline infusion ( unlikely) 4. Ipatropium nebs in severe/life threatening asthma

Question 33

Examples of SABA

Answer 33

Salbutamol, terbutaline

Question 34

Example of an antimuscarinic used in asthma

Answer 34

Ipratropium

Question 35

When should blood levels for Aminphylline be taken?

Answer 35

4 -6 hours post oral dose or when starting/changing infusion

Question 36

Target level for aminophylline

Answer 36

10-20mg/L

Question 37

ADR associated wiht SAlbutamol and terbutaline

Answer 37

Fine tremor (esp hands), headache, tachycardia

Question 38

ADRS associated wiht ICS

Answer 38

Oral candidiasis, headache, altered taste and voice

Question 39

How quickly dose SABAs act and wean off?

Answer 39

act within 3-5 minutes, effecg wears off within 4 - 6 hours

Question 40

Sied effects of LTRA

Answer 40

diarrhoea, vomiting, fever, nausea, abdominal pain

Question 41

Side effects of LAMA

Answer 41

acute close angle glaucoma, dry mouth, constipation

Question 42

Examples of methylxanthines

Answer 42

Aminophylline, theophylline

Question 43

Low potency ICS example

Answer 43

Budesonide 400mcg BD

Question 44

Moderate dose ICS example

Answer 44

Budesonide 400-800mcg BD

Question 45

High dose ICS example

Answer 45

>800mcg BD budesonide

Question 46

When should LTRA be taken?

Answer 46

in the evening

Question 47

Example of LABAs

Answer 47

Salmeterol annd Fometerol

Question 48

What drug is in spiriva respimat?

Answer 48

Tiotropium (LAMA)

Question 49

What asthma medication should be prescribed as brand specifically?

Answer 49

Theophylline