Asthma

Question 1

Treatment of mild or moderate acute asthma attack? (3)

Answer 1

• Salbutamol inhalation MDI 400 -800 mcg (4-8 puffs) using spacer
Allow for 4 breaths through spacer between puffs. Repeat every 20-30 min in first hour if no relief. There after repeat every 2-4 hours if needed . Better than nebuliser.
Or
• salbutamol 0,5 % solution nebulised at flow rate 8L/min with oxygen
1ml (5 mg) solution in 4 ml sodium chloride 0,9%. Repeat as above
And
Prednisone oral 40 mg immediately if pt known with asthma/ COPD
Follow with prednisone oral 40 mg daily for 7 days

Question 2

Treatment of Severe acute asthma attack? (7)

Answer 2

• Oxygen 40% or higher using highest concentration. Face mask. In COPD give with care preferably 24 or 28% and observe closely, may deteriorate
And
• salbutamol 0.5% solution nebulised flow rate 8 l/ min with oxygen
Or
• salbutamol inhalation MDI 400 - 800 mcg (4-8 puffs) up to 20 puffs using spacer.
If no relief repeat every 20-30 min until PEF >60% of predicted
Once PEF > 60% of predicted, repeat every 2-4 hours if needed
And
Prednisone oral 40mg immediately and follow for 7 days
Or
Hydrocortisone IM or slow iv 100 mg and fallow with prednisone 40 mg 7 days

Add if poor response
Ipratropium bromide solution 0,5 mg nebulised,2 ml ( 0,5 mg) added to salbutamol solution every 20-30 min for 3 doses depending on clin response
Or
Ipratropium bromide inhalation MDI 80-160 mcg (2-4 puffs) with spacer every 20-30 min as needed for up to 3 hours

Question 3

Name 6 differences between COPD and asthma

Answer 3

• asthma young age onset less than 20 vs COPD older usually >40
• History hay fever, eczema and/or allergies vs slowly worsen over long period time
• family history asthma vs history heavy smoking (>20 cigs per day for 15 or more years), heavy cannabis use, previous TB
• symptoms intermittent with periods normal breathing in between vs long history daily/frequent cough before onset SOB
• symptoms worse at night or early morning, during URTI, when weather change or when upset vs persistent
• marked improvement with beta 2 agonist vs little improvement

Question 4

How is asthma diagnosed? (Confirm)

Answer 4

• Improvement PEFR of 60 l/min or ≥ 20% of pre-bronchondilator PEFR 10-20 min after inhalation beta 2 agonist eg salbutamol 200 mcg
• normal PEFR also exclude possibility of mild and severe. COPD

Question 5

How assess response to therapy asthma?

Answer 5

Any value on PEFR > 80% of personal best before use of bronchodilator = adequate control

Question 6

Define mild intermittent asthma (4)

Answer 6

• Day time symptoms ≤2 episodes daytime cough and or wheeze per week
• night time symptoms ≤1 cough and or wheeze per month
• PEFR ≥ 80% predicted between attacks
• No admissions to hospital for acute exacerbations in last 12 months.

Question 7

Drug interaction with budesonide/fluticasone?

Answer 7

Protease inhibitors

Question 8

What spacer volume should be used for inhalation therapy in asthma?

Answer 8

750 ml

Question 9

Treatment for mild intermittent asthma?

Answer 9

Saba eg salbutamol inhalation 100-200 mcg (1-2 puffs) 6-8 hourly as needed until symptoms controlled

Question 10

Treatment for persistent asthma?

Answer 10

• Inhaled corticosteroids (controller) eg budesonidone inhalation 200 mcg 12 hourly
Then once diagnosis confirmed after inadequate control, step up to 400 mcg 12 hourly
And
• saba (reliever) eg salbutamol 100-200 mcg (1-2 puffs) 6-8 hourly as needed until controlled

Question 11

Define adequate control of asthma (4)

Answer 11

• 2 or less episodes of daytime cough and or wheeze per week
• No night time cough and or wheeze
• No recent (within last year) admission to hospital for asthma
• PEFR ≥ 80% predicted between attacks

Question 12

Treatment for uncontrolled persistent asthma?

Answer 12

• Stop inhaled corticosteroid (budesonide) and replace with

Inhaled LABA / corticosteroid combination eg salmeterol /fluticasone inhalation 50 / 250 mcg (1 puff) 12 hourly

Question 13

Name 5 side effects corticosteroids

Answer 13

• Weight gain
• hypertension
. Hyperglycemias
• osteopenia
• decreased immunity
• peptic ulcer disease 
• fluid retention
• change in behaviour or mood

Question 14

Which 3 drugs should patients be advised can make asthma worse?

Answer 14

• Aspirin
• NSAIDs
• beta blockers

Question 15

MDI technique? (9)

Answer 15

1. Shake to mix medication+-propellant
2. Remove cap, check no fb in inhaler
3. Hold upright
4. Exhale fully
5. Place lips closely around mouthpiece
6. Activate by press down on canister and at same time take slow, deep breath. Only 1 puff at a time
7. After breathing in, hold breath up to 10 sec
8. Wait 1 min and repeat if needed
   9 Wash mouth