Asthma Flashcards
What are six non-pharmacological issues to address when assessing asthma?
Inhaler technique, adherence to treatment, exposure to triggers, managing comorbidities (eg. GORD, rhinitis), written action plan, immunisations.
What are the 4 features of good asthma control?
Daytime symptoms ≤ 2 days/week, using SABA ≤ 2 days/week, no limitation to activities, no night or waking symptoms.
What are the features of asthma on spirometry?
Adults: FEV1/FVC <LLN. FEV1 increases by 200mL and 12% with bronchodilator. Kids: FEV1 increases by 12% with bronchodilator.
Child with asthma can have normal FEV1
What are some features supportive and not supportive of an asthma diagnosis?
Wheeze, chest tightness, FHx allergies, seasonal, night symptoms. Not: only with URTI, no clinical signs when sick, isolated cough, dizziness/ligthheaded.
What are 2 inhaler options that can be used for SMART therapy?
Symbicort turbuhaler = budesonide/formeterol 200/6. Symbicort rapihaler = 100/3.
What are 2 low and high dose inhaled steroids for adults and children?
Budesonide - adults 200-400 (L), 500-800 (M), >800. Kids: 200-400 (L) >400 (H). Fluticasone propionate - adults 100-200 (L), 250-500 (M), >500 (H). Kids: 100-200 (L), >200 (H)
What are the features of severe and life-threatening acute asthma?
S: accessory muscle use, unable to speak sentences, sats 90-94%. LT: exhaustion, decreased LOC, sats < 90%, poor resp effort.
What is first aid treatment for asthma in the community?
Sit upright. 4 puffs salbutatmol with 4 breaths each, repeat after 4 mins. Symbicort: 2 puffs, 1 puff 4 min later.
Call AV if not improving after 1st cycle or concerned.
How do you manage acute asthma in a clinical setting (not life threatening)
Salbutamol 6-12 puffs (Max 6 if < 6) every 20 mins. If severe consider 2.5-5mg nebule & add ipratropium 4-8 puffs OR 250-500microg nebule. Aim oxygen >94%
MgSo4 if poor response, steroids 3-5 or 5-10d within 1 hour.
How do you manage life threatening asthma?
Salbutamol 2x 5mg or 2x 2.5mg + ipratropium 250/500microg nebules via continuous nebulisation driven by oxygen, ventilate if required, aim oxygen 93-95% or >95% in kids.
What are the theoretical SE of ICS in children?
Hoarseness, candida rare. Short term growth suppression - unclear, dose dependent. HPA axis suppression - adrenal insufficiency. No effect on bone density.
What are 3 forms of occupational asthma?
Work exacerbated asthma (prev asthma, worse at work). Sensitiser induced occupational asthma - often weeks after exposure, worse during or after shift, improve when away. Irritant induced occupational asthma - within 24hr of exposure to large amount of irritant with symptoms for 3mo after, without prev diagnosis.
