Airways Diseases

Question 1

What is asthma?

Answer 1

airway disease characterised by variable airflow obstruction, bronchial hyper responsiveness and airway inflammation

Question 2

How do you confirm bronchial hyper-responsiveness?

Answer 2

with a bronchial challenge

Question 3

How do you assess airway inflammation?

Answer 3

measure exhaled nitric oxide

or measure blood eosinophil count

Question 4

What are the risk factors for asthma exacerbations?

Answer 4

ever intubated for asthma
uncontrolled asthma symptoms
> 1 exacerbation in last 12/12
low FEV1
incorrect inhaler technique/poor adherence
smoking
elevated exhaled nitric oxide
obesity
pregnancy
blood eosinophilia

Question 5

What is Samter’s triad?

Answer 5

asthma, aspirin intolerance and nasal polyps

Question 6

What is ABPA?

Answer 6

chronic asthma, recurrent pulmonary infiltrates, bronchiectasis

Question 7

What is the first step in asthma management?

Answer 7

PRN low dose ICS-formoterol with PRN SABA

Question 8

What is the second step in asthma management?

Answer 8

daily ICS or PRN ICS-formoterol with PRN SABA

Question 9

What is the third step in asthma management?

Answer 9

daily low dose ICS-LABA with PRN SABA

Question 10

What is the fourth step in asthma management?

Answer 10

daily medium dose ICS-LABA with PRN SABA

Question 11

What is the fifth step in asthma management?

Answer 11

daily high dose ICS-LABA with PRN SABA and refer for other add on therapy

Question 12

What are some add on therapies for severe asthma?

Answer 12

tiotropium, macrolides, montelukast, monoclonal antibodies

Question 13

What monoclonal antibody should be used for allergic asthma?

Answer 13

omalizumab

Question 14

What monoclonal antibodies should be used for eosinophilic asthma?

Answer 14

mepolizumab, benralizumab

Question 15

What are the steps in COPD-X?

Answer 15

Confirm diagnosis (spirometry)
Optimise function (rehab, inhalers)
Prevent deterioration (smoking cessation, vaccinations)
Develop action plan
Exacerbation management

Question 16

How is COPD diagnosed with spirometry?

Answer 16

post bronchodilator FEV1/FVC ratio < 0.7 (not fully reversible)

Question 17

What are the options for short acting bronchodilators (relievers)?

Answer 17

salbutamol (SABA)
terbutaline (SABA)
ipratropium (SAMA)

Question 18

What are the options for long acting bronchodilators?

Answer 18

tiotropium (spiriva) (LAMA)
actidinium (bretaris) (LAMA)
indacaterol (onbrez) (LABA)
umeclidinium (incruse) (LAMA)
glycopyrronium (seebri) (LAMA)

Question 19

What are the options for combined LABA/LAMAs?

Answer 19

tiotropium/olodaterol (spiolto)
indacaterol/glycopyrronium (ultibro)
umeclidinium/vilanterl (anoro)
aclidinium/formoterol (brimica)

Question 20

What is seretide?

Answer 20

fluticasone/salmeterol (ICS + LABA)

Question 21

What is trelegy?

Answer 21

fluticasone/umeclidinium/vilaterol (ICS + LABA + LAMA)

Question 22

What is breo ellipta?

Answer 22

fluticasone/vilanterol (ICS + LABA)

Question 23

What is symbicort?

Answer 23

budesonide/formoterol (ICS + LABA)

Question 24

What are the steps for pharmacological therapy for COPD?

Answer 24

start with short acting relievers (SABA or SAMA)
then add long acting bronchodilator (usually LAMA can use LABA)
then consider adding ICS (usually give as ICS/LABA plus LAMA but can use single inhaler triple therapy)

Question 25

Which patients should you consider adding ICS?

Answer 25

FEV < 50% predicted
and > two exacerbation in last 12 months
and significant symptoms despite LAMA/LABA therapy

Question 26

What did the IMPACT study show?

Answer 26

once daily single inhaler triple therapy superior to ICS/LABA or LAMA/LABA with reduced rate of exacerbations however increased pneumonia risk with triple therapy compared to LAMA/LABA

Question 27

When is NIV indicated in a COPD exacerbation?

Answer 27

acute type 2 respiratory failure, low pH, increased CO2