Asthma

Question 1

Differential diagnosis of asthma

Answer 1

COPD
Bronchiectasis
Pneumonia
TB

Question 2

Diagnosis

Answer 2

Spirometer + bronchodilators reversibility test
FeNO
Airway hyperreactivitiy test = histamine direct bronchial challenge
Peak expiratory flow rate = every day 2-4 weeks
Chest X-ray
Allergy testing

Question 3

Treatment of asthma

Answer 3

1. SABA (Salbutamol)
2. SABA + ICS (Salbutamol + budesonide)
3. SABA + ICS + LTRA (Leukotriene receptor antagonist) = (Salbutamol + Budesonide + Montelukast
4. SABA + ICS + LABA (Salbutamol + Budesonide + Salmeterol

(In adults fourth line = SABA + ICS + LABA + LTRA)

Question 4

Inhaler devices

Answer 4

Pressurised metered dose inhalers (MDIs)
Advantages
- portable and convenient
- cost effective
- no prep
Disadvantages
- patient co-ordination essential
- high pharyngeal deposition
- difficult to determine remaining doses
Breath-activated inhalers - MDIs
Advantages
- portable
- no co-cordination or high flow rate required
Disadvantage
- limited range available
Dry powder inhalers.
Advantages
- Portable and
- Propellant not required.
- Patient co-ordination not required.
- No need for spacer.
- Most have dose counters.
Disadvantages
- Difficult to deliver in high doses
- Flow dependent.
- Some require assembly
- More expensive than metered dose inhaler.
- Cannot use with endotracheal or tracheostomy tube
Nebulisers.

Question 5

Wrong things to do when using inhaler

Answer 5

• Not shaking the inhaler before using it.
• Inhaling too sharply or at the wrong time.
• Not holding your breath long enough after breathing in the contents.

Question 6

How to use an inhaler

Answer 6

If you have not used the inhaler in a while, you may need to prime it. See the instructions that came with your inhaler for when and how to do this.
Take the cap off.
Look inside the mouthpiece and make sure there is nothing in it.
Shake the inhaler hard 10 to 15 times before each use.
Breathe out all the way.

Hold the inhaler with the mouthpiece down. Place your lips around the mouthpiece so that you form a tight seal.
As you start to slowly breathe in through your mouth, press down on the inhaler one time.
Keep breathing in slowly, as deeply as you can.

Take the inhaler out of your mouth. If you can, hold your breath as you slowly count to 10. This lets the medicine reach deep into your lungs.
Pucker your lips and breathe out slowly through your mouth.
If you are using inhaled, quick-relief medicine (beta-agonists), wait 1 to 2 minutes before you take your next puff. You do not need to wait between puffs for other medicines.

After using your inhaler, rinse your mouth with water, gargle, and spit. Do not swallow the water. This helps reduce side effects from your medicine.