Asthma

Question 1

Presentation of acute asthma

Answer 1

Progressively worse SOB, signs of respiratory distress, tachycardic, expiratory wheeze, silent chest

Question 2

Signs of moderate acute asthma

Answer 2

Peak flow >50%, normal speech, no other features of severe or life threatening asthma

Question 3

Signs of severe asthma

Answer 3

Peak flow <50%, sats <92%, unable to complete sentences in one breath, signs of respiratory distress, tachycardic, tachypnoeic

Question 4

Signs of life threatening asthma

Answer 4

Peak flow <33%, sats <92%, exhaustion, poor resp rate, hypotension, silent chest, cyanosis, altered consciousness, confusion

Question 5

Management of acute asthma attack

Answer 5

Supplemental oxygen, bronchodilators, steroids, antibiotics if infective cause,

Question 6

Management of mild acute asthma as outpatient

Answer 6

Regular salbutamol inhalers with spacer with 4-6 puffs every 4 hours

Question 7

4 main bronchodilators used

Answer 7

Salbutamol, ipatropium bromide, IV Mg sulfate, IV aminophylline

Question 8

When to discharge patient home after acute asthma

Answer 8

When the child is well on 6 puffs 4 hourly salbutamol, to take home on reducing regime and finish course of steroids

Question 9

Presentation suggesting chronic asthma

Answer 9

Episodic symptoms with intermittent exacerbations, diurnal variability, typically worse at night and early morning, dry cough, wheeze, SOB, typical triggers, history of atopic disease, FHx, bilateral widespread wheeze

Question 10

Diagnosis of asthma

Answer 10

Not typically diagnosed until 2/3 years old, trial of treatment started if high probability, spirometry with reversibility testing, direct bronchial challenge test, peak flow diary

Question 11

Medical therapy for asthma for under 5 year old

Answer 11

Salbutamol inhaler, as required, add low dose corticosteroid inhaler, or leukotriene antagonist, add other option from step 2 and then refer to specialist

Question 12

Corticosteroid inhalers

Answer 12

Beclometasone

Question 13

Leukortiene receptor antagonist

Answer 13

Montelukast

Question 14

Medical therapy for asthma in children 5-12 years old

Answer 14

Salbutamol, low dose corticosteroid inhaler, salmeterol, titrate up to corticosteroid to medium dose, consider adding leukotriene receptor antagonist or oral theophylline, increased inhaled corticosteroid to highest dose, refer to specialist