Asthma

Question 1

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

Answer 1

Moderate acute asthma

Question 2

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

Answer 2

Severe acute asthma

Question 3

PEFR < 33% best or predicted
Oxygen sats < 92%
Silent chest, cyanosis or feeble respiratory effort
Bradycardia, dysrhythmia or hypotension
Exhaustion, confusion or coma

Answer 3

life-threatening acute asthma

Question 4

When should patients with an acute asthma attack be admitted?

Answer 4

• life-threatening/ near fatal
• severe (if not responding to initial treatment)
• pregnancy
• attack despite already using oral steroids

Question 5

Main features of acute asthma management

Answer 5

• Oxygen
• Nebulised SABA (salbutamol)
• Oral Steroids (40-50mg pred.)
• SAMA (ipratropium)
• IV magnesium sulphate
• IV aminophylline
• Escalate to HDU/ITU for intubation/ventilation/ ECMO

Question 6

Criteria for discharge following acute asthma attack

Answer 6

• No nebulisers or oxygen for 12–24 hours
• inhaler technique checked and recorded
• PEF >75% of best or predicted

Question 7

Investigations used to diagnose asthma

Answer 7

Spirometry
Bronchodilator reversibility testing
fractional exhaled nitric oxide (FeNO)

Question 8

Describe the result expected on spirometry in patients with asthma

Answer 8

Obstructive pattern

Question 9

Describe the result expected in a patient with asthma during bronchodilator reversibility testing

Answer 9

improvement in FEV1 of 12% or more

Question 10

Describe the result expected from a fractional exhaled nitric oxide (FeNO) test in a patient with asthma

Answer 10

high levels of NO can indicate inflammation
=> adults >40ppm = positive
=> children >35ppm = positive

Question 11

Steps of asthma treatment in adults

Answer 11

1. SABA
2. SABA + ICS
3. SABA + ICS + LTRA
4. SABA + ICS + LABA (continue LTRA if responding)
5. SABA+ LTRA + MART

Question 12

Options for scaling up treatment if not controlled with SABA+LTRA+MART

Answer 12

• high-dose ICS (not as a MART)
• trial of LAMA or theophylline
• referral to respiratory

Question 13

What is meant by Maintenance and Reliever therapy (MART)

Answer 13

ICS+LABA in a single inhaler

fast-acting LABA (e.g formoterol)

Question 14

Describe the difference between a LOW, MODERATE and HIGH dose ICS

Answer 14

LOW <= 400mcg budesonide or equivalent

MODERATE = 400-800mcg budesonide or equivalent

HIGH > 800 mcg budesonide or equivalent

Question 15

Compounds associated with occupational asthma

Answer 15

isocyanates (most common)
=> example occupations include spray painting and foam moulding using adhesives

Others:
- platinum salts
- soldering flux resin
- glutaraldehyde
- flour
- epoxy resins
- proteolytic enzymes

Question 16

how is occupational asthma diagnosed?

Answer 16

Serial measurements of peak flow are recommended at work and away from work for comparison

Question 17

Referral should be made to a respiratory specialist for patients with suspected occupational asthma. TRUE/FALSE?

Answer 17

TRUE