asthma

Question 1

what is step 1 in asthma management?

Answer 1

SABA short acting beta 2 agonist
salbutamol

Question 2

what is step 2 in asthma management?

Answer 2

SABA
Low-dose ICS inhaled corticosteroid
eg beclometasone, budesonide, ciclesonide, fluticasone, and mometasone

Question 3

what is step 3 in asthma management?

Answer 3

SABA
low-dose ICS
LTRA- leukotriene receptor antagonist eg montelukast

Question 4

what is step 4 in asthma management?

Answer 4

SABA
low-dose ICS
LABA eg salmeterol, formoterol

continue LTRA depending on patient’s response

Question 5

what is step 5 of asthma management?

Answer 5

SABA +/- LTRA + MART

MART (includes LABA + low-dose ICS)

eg fostair/symbicort

Question 6

what is step 6 of asthma management?

Answer 6

SABA +/- LTRA + medium-dose ICS MART

or consider changing back to fixed-dose of a moderate-dose ICS + separate LABA

Question 7

what is step 7 in asthma management?

Answer 7

SABA +/- LTRA + one of:

1. increase ICS to high-dose
2. trial additional drug eg LAMA long-acting muscarinic receptor antagonist (eg tiotropium) or theophylline
3. specialist advice

Question 8

what is definition of low-dose ICS?

Answer 8

<400micrograms budesonide

Question 9

what is definition of medium dose ICS?

Answer 9

400-800 micrograms

Question 10

what is definition of high dose ICS?

Answer 10

> 800 micrograms

Question 11

what are the features of moderate acute asthma?

Answer 11

PEFR 50-75% best or predicted
Speech normal
RR < 25 / min
Pulse < 110 bpm

Question 12

what are the features of severe acute asthma?

Answer 12

PEFR 33 - 50% best or predicted
Can’t complete sentences
RR > 25/min
Pulse > 110 bpm

Question 13

what are the signs of life-threatening asthma?

Answer 13

PEFR < 33% best or predicted
Oxygen sats < 92%
‘Normal’ pC02 (4.6-6.0 kPa)
Silent chest, cyanosis or feeble respiratory effort
Bradycardia, dysrhythmia or hypotension
Exhaustion, confusion or coma

Question 14

what are the signs of near-fatal asthma?

Answer 14

raised pC02
requiring mechanical ventilation with raised inflation pressures.

Question 14

when do you take an ABG according to BTS guidelines?

Answer 14

when oxygen<92%

Question 15

when do you need a CXR?

Answer 15

life-threatening asthma
suspected pneumothorax
failure to respond to treatment

Question 16

when do you admit patients with asthma?

Answer 16

life-threatening asthma
severe acute asthma if failed to respond to initial treatment
previous near-fatal asthma attack
pregnancy
attack if already on PO corticosteroids + presentation at night

Question 17

what is the criteria for discharge?

Answer 17

stable on their discharge medication (i.e. no nebulisers or oxygen) for 12–24 hours
inhaler technique checked + recorded
PEF >75% of best or predicted

Question 18

how do you treat acute asthma?

Answer 18

O- oxygen until 94-98%

S- salbutamol nebs if life-threatening or near-fatal asthma, pMD1 if other

H- 40-50mg PO pred for 5 days or until attack recovered; continue routine ICS

I- ipratropium bromide in patients with severe or life-threatening asthma, or in patients who have not responded to beta₂-agonist and corticosteroid treatment

T- theopylline/aminophylline after sr rv

M- IV MgSO4 severe/life-threatening asthma

Escalate
- intubation + ventilation
- extracorporeal membrane oxygenation (ECMO)