16. Asthma

Question 1

Sx asthme 5 et ensuite

Answer 1

paroxysmal or persistant sx:
- dyspnée
- opression thoracique (chest thightness)
- respi bruyante (wheeze)
- toux
- expecto

AND
confirmation avec spiro

Question 2

confirmation avec spiro asthem adultes vs kids 6-18ans

Answer 2

FEV1/FVC (VEMS/CVF (indice de Tiffeneau) < 0.75-0.80
Avec SABA ou test methilcholine augmentation du du FEV1 de 10% (avant 12%) ET 200ml

Kids: Tiffeneau) < 0.80-0.90

Question 3

ddx asthme adults (6) kids (8)

Answer 3

Adults
* Infectieux:
- IVRS
- Pneumonie
* RGO
* IC
* Masse médiastinale
* Rx

Kids
* Infectieux:
- Croup (laryngo-tracheo-bronchitis)
- Bronchiolite
- laryngite
- coqueluche
- Pneumonie
* Aspiration de corps étranger
* Fibrose kystique
* Anomalies trachéobonchiques: laryngomalycie (stridor congénital ad 2 ans) !
* Maladie cardiaque congenitale

Question 4

Toux déclenchée par aliments ou boissons, il faut penser à

Answer 4

eosophagite esophagienne

Question 5

Sx control questions for asthma (4)

Answer 5

Dans les 4 dernières sem:

• Daytime sx > 2/week
• Reliever (SABA) use >2/week
• Night-time waking due to asthma
• Activity limitation due to asthma

Question 6

LAMA definition and also known

Answer 6

long-acting muscarinic antagonist (LAMA, also known as anticholinergic)

Question 7

Tx asthme and tx escalation track 1 vs 2

Answer 7

ASTHME - Preferred ‘track 1’ (x 2021)
inhaled corticosteroide (ICS) /formoterol (long-acting beta2-agonist)
= Cortico + LABA
= SYMBICORT
1) au début PRN low dose
2) maintenance LOW dose et PRN low dose
3) maintenance MEDIUM dose et PRN low dose (bon pratique prob med dose maintenance + PRN)
4) Add on LAMA
- refer for phenotypic assessment (+- anti-IgE Anti-IL5 etc)
consider HIGH dose ICS-formoterol

Question 8

Résumé Tx asthme vs COPD

Answer 8

ASTHME
A) Preferred ‘track 1’:
1) cortico + LABA (+idem pour PRN)
2) augmentation des doses

B) Alternative ‘track 2’:
1) ICS+SABA (les deux au même temps PRN)
2) ICS maintenance + SABA PRN
3) ICS+LABA maintenance + SABA PRN
4) augmentation doses

COPD
1) LAMA (+ SABA PRN)
2) LAMA + LABA (+ SABA PRN)
3) LAMA + LABA + CSI (+ SABA PRN)

Question 9

Risk factors for astham exacerb

Answer 9

Future risk of adverse outcomes (independent of symptom control)

History of ≥ 1 exacerbation in previous year

Poor adherence

Incorrect inhaler technique

Low lung function

Smoking

Blood eosinophilia

Question 10

Rx that could worsen ASTHMA

Answer 10

NSAIDS
bronchospams 30 minutes to 3 hours
unclear pathophysio

BB - blocking airway β2-receptors
bronchoconstriction

Question 11

If severe asthma exacerbation