Asthma

Question 1

Risks for Asthma (3)

Answer 1

Atopy
Frequent use of cleaning products
Early life exposure to pets if both parents atopic

Question 2

DDX (7)

Answer 2

COPD
CHF
Medications 
GERD
Foreign body 
UACS
CF
PE

Question 3

External Triggers for asthma (7)

Answer 3

Cold air
Exercise
Viral illness
Allergens
Smoking 
Sulphites in foods 
Beta blockers 
NSAIDS 
Strong emotions

Question 4

Comorbidities that can aggravate asthma (5)

Answer 4

Rhinosinusitis
Sleep apnea 
GERD
Obesity
Stress/anxiety

Question 5

Diagnosis <6 yo

Answer 5

1. Documented airflow obstruction (cough, wheezing)
2. Reversibility of airflow obstructions (improves with SABA)
   - Give ventolin 4 puffs reassess in 30-60 minutes can repeat dose
3. No evidence of alternative diagnosis

Question 6

DDX in children (3)

Answer 6

Croup
Foreign body
CF
Bronchiolitis

Question 7

Criteria to determine if asthma is controlled

Answer 7

<2 days with symptoms 
<2 doses of reliever 
<1 night with symptoms 
Not interfering with activity 
Infrequent and mild exacerbations (this is determined by the patient)

Question 8

Diagnosis of asthma

Answer 8

Fev1/FVC ratio <0.75 (COPD is 0.7)

FEV1 12% increase post bronchodilator (COPD is not reversible)

Question 9

How would you assess severity of Asthma exacerbation in kids

Answer 9

PRAM score 
O2 saturation 
Indrawing/retractions 
Air entry on exam 
Wheezing (Expiratoy

Question 10

Non pharm management

Answer 10

Aerobic exercise
Smoking cessation
Avoid NSAIDS and Beta blockers
Avoid allergens (Caution in chlorine swimming pools in childlren)
Annual influenza vaccination (but less evidence than COPD)

Question 11

How to treat Asthma age > 12

Answer 11

PRN Symbicort
Then Maintenance and PRN Symbicort
Second line is LTRA (Leukotriene receptor antagonist) but black box warning for suicidality
Increase dose of ICS

Add LABA
Add LTRA
Add Biologics (Resilzumab, Benralizumab)

Question 12

What to do if symptoms not well controlled (5)

Answer 12

Escalate therapy 
Control triggers
Check adherence 
Check comorbidities 
Inhaler technique
Repeat spirometry

Question 13

Criteria for hospital admission

Answer 13

Unable to speak sentences 
Tachypnea 
Tachycardia
PEF <40%
Silent chest
Cyanosis
Confusion

Question 14

Management in hospital

Answer 14

ABCS
SABA (4-8 puffs q 1-4 hrs)
Oral steroids or IV steroids (methypredisolone 40 mg IV q 12h)
Ipatropium (atrovent 4-8 puffs q 20 minutes
Mg SO4 2g IV

Question 15

Treatment in children 6-11

Answer 15

1. SABA PRN WITH low dose ICS PRN
2. Dialy low dose ICS with PRN SABA
3. Daily Symbicort with PRN SABA
4. Increase sode of Symbicort

Question 16

Management of URTI/Exacerbations

Answer 16

Increase symbicort by 4x

Prednisolone 50 mg /day x 5 days