Asthma

Question 1

Classification of asthma exacerbations

Answer 1

Mild/Moderate
- Can walk/speak in sentences/ Sats > 94%
Severe
- Accessory muscle use. Sats 90-94%. Unable to speak in sentences in one breath.
Life-threatening
- Reduced LOC. Syncope. Cyanosis. Sats < 90%. Soft or absent breath sounds.

Question 2

Management of Acute Asthma in Children

Answer 2

Mild/Mod
- Salbutamol 100microg MDI+Spacer 4-12 puffs if 6+yo or 2-6 puffs if 2-5yo.
Severe
- Salbutamol 100microg MDI+ Spacer 12 puffs if > 6+yo or 6 puffs if 2-5yo.
- Salbutamol Nebuliser 2.5mg-5mg according to age as per above
- Ipratropium 21microg MDI+Spacer 8puffs if 6+yo or 4puffs if 2-5yo.
- Ipratropium nebulised 250microg or 500microg as per above
- O2 aim sats >= 95%
Life threatening
- Nebuliser only
6+yo - 2.x 5mg nebules salbutamol + 500 microg Ipratropium
- O2 Aim sats >= 95%
- Poor response? Add MgSO4 0.1-0.2mmol/kg to max of 10mmol IVIF over 20 mins.
- Organise rapid transfer to tertiary facility.
Give prednisolone 1mg/kg PO OD x 3 days for severe+attacks. If unable to tolerate PO. Can give IV Hydrocortisone or Methylprednisolone

Question 3

Management of Acute Asthma in Adults

Answer 3

Treat as per severity (Mod/Severe/Life threatening)

Severe
- Salbutamol 100microg MDI 12 puffs Q20min first hour then review
- Ipratropium 21mirog MDI 8 puffs Q20min first hour then review.
Oxygen aim sats >=95%
- Prednisolone 50mg PO Daily x 5-10 days. IV Hydrocortisone if unable to take orally
- No response? Consider IV Mgso4 10mmol IVIF over 20 mins

Life-threatening
- Neb 2x5mg salbutamol + 500microg Ipratropium
- O2 Aim sats 93-95%

Question 4

Asthma management Steps for Adults and Adolescents

Answer 4

5 - Specialist input
4 - Regular ICS-LABA (Medium/High Dose)
3 - Regular ICS-LABA (Low Dose)
2 - Regular ICS (Low Dose) + SABA Reliever
Or Budesonide- Formoterol PRN
1 - SABA PRN

Question 5

Asthma management Steps for Children aged 6-11 years

Answer 5

4 - Specialist input
3 - Regular ICS (High paeds dose) / ICS+LABA (Low Paeds dose) or ICS (Low dose) + Montelukast
2 - Regular ICS (Low Dose) or Montelukast
1 - SABA PRN
Consider stepping

Question 6

Definitions of ICS dose levels in Adults (Low/Med/High) Total daily dose

Answer 6

Budesonide 200-400 / 500-800 / >800
Fluticasone Furoate 50/100/200
Fluticasone Proprionate 100-200/250-500/>500

Question 7

Asthma Control Definitions

Answer 7

Good
- <= 2x daytime symptoms per week. No limitation of activities. No nighttime symptoms or symptoms on waking.
Partial (Up to 2 of following)
- >2x daytime symptoms per week. Any limitation of activities. Symptoms on waking or during night. Need for reliever > 2 times per week.
Poor (Three or more of above)

Question 8

Indication for referral to Respiratory physician

Answer 8

Severe asthma with the following
- Following life-threatening asthma exacerbation requiring hospitalisation
- Suspected occupational asthma
- Frequent asthma attacks prompting review with GP.
- Frequent chest infections
- Diagnostic Uncertainty ?COPD intercurrent
- Consideration for Home O2 if COPD intercurrent.
- COPD < 40 years of age ?a1-antitrypsin deficiency

Question 9

Education regarding SE of inhaled corticosteroids in paediatric patients

Answer 9

• Local Adverse effects
  
  • Hoarseness of voice
  • Oropharyngeal and Laryngeal candidiasis
    
    • Use a spacer. Wash mouth out after use.
• Systemic Adverse Effects
  
  • Growth - Mean reduction of 0.48-0.61cm per year in linear growth velocity. Effect is dose-dependent.
  • Adrenal suppression - Occur in 2/3rds if patients even at low doses
    
    • Most cases of clinical adrenal insufficiency occure with a 500microg per day dose of fluticasone.
    • Symptoms - Hypoglycaemia, weakness, failure to grow, hypotension.