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RESPIRATORY DISEASE AND GENITOURINARY DISEASE TOPIC - PRE REG > Asthma > Flashcards

Asthma Flashcards

1
Q

What is the peak flow of moderate acute asthma

A

Peak flow >50%

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2
Q

Are moderate acute asthmatic patients able to complete full sentences

A

Yes

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3
Q

What is the SpO2 in moderate acute asthma

A

> or equal to 92%

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4
Q

What is the respiratory rate of moderate acute asthma

A

< or equal to 30 (children 5+)
< or equal to 40 (children 1-5)

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5
Q

What is the peak flow of severe acute asthma

A

Peak flow 33-50% (Fev)

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6
Q

Are patients who have severe acute asthma able to complete full sentences

A

No

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7
Q

What is the respiratory rate of severe acute asthma

A

> or equal to 25 (adult)
30 (children 5+)
40 (children 1-5)

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8
Q

What is the heart rate of those with sever acute asthma

A

> 125 BPM (children 5+)
140 BPM (children 1-5)

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9
Q

What is the peak flow of those who have life threatening acute asthma

A

< 33%

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10
Q

What is the SpO2 for those with life threatening acute asthma

A

< 92%

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11
Q

What are some of the side effects of life threatening acute asthma

A

Cyanosis
Silent chest
Altered consciousness
Hypotension
Exhaustion

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12
Q

How do you manage moderate acute asthma in adults

A

Home or in primary care- hospital if inadequate response
Treatment: high dose SABA (salbutamol) via PMI or spacer
Give 8-10 puffs of salbutamol one after the other until adequate relief in people who have an asthma attack

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13
Q

How do you manage severe or life threatening acute asthma

A

Hospital immediately
Treatment : high dose SABA (salbutamol ) via oxygen-driven nebuliser +/ nebuliser ipratropium

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14
Q

How do you manage a near fatal or life threatening with poor response to initial therapy

A

IV aminophylline

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15
Q

What must all patients have when managing acute asthma in adults

A

all patients: oral prednisolone for 5 days- if inappropriate: IV hydrocortisone or IM methylprednisolone

In hypoxaemic patients: supplementary oxygen (maintain SpO2 between 94-98%)

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16
Q

What is the acute asthma management for children 2 years and over

A

Severe or life threatening- hospital immediately (oxygen in life threatening acute asthma or SpO2 <94%)

First line treatment: SABA (salbutamol)
-mid to moderate: PMI and spacer- medical attention if symptoms are not controlled with up to 10 puffs
- sever or life threatening- via an oxygen driven nebuliser

In all cases: 3 days oral prednisolone
Poor initial response to beta2 agonist: add nebulised ipratropium
In response to first line treatments: IV magnesium sulfate

17
Q

How do you manage acute asthma for children under 2 years old

A

All children under 2- hospital setting
Moderate and severe: immediate oxygen + trail of SABA
If needed combine nebulised ipratropium bromide

18
Q

What lifestyle changes would you recommend with someone with chronic asthma

A

Weight loss in overweight patients
Smoking cessation
Breathing exercise programmes

19
Q

What is the chronic asthma management plan on adults

A

Step 1: intermittent reliever (SABA)

Step 2: SABA + low dose regular preventer (Inhaled CorticoSteroid)
- start ICS if asthma is uncontrolled by SABA alone (use SABA 3X a week, symptoms 3x a week, night time awakening at least once a week, using >1 inhaler per month

Step 3: SABA + ICS
- LTRA such as montelukast (NICE)
- LABA (BTS/SIGN)- fixed dose or as MART (maintenance and reliever therapy)
* MART using regular medication has a reliever aswell such as FOSTAIR (Combination of LABA and ICS) or symbicort
LABA stands for long acting beta-adrenoceptors agonist or long acting bronchodilator inhalers

Step 4: LABA if not already added
- can be given with or without LTRA
- can convert fixed dose LABA + moderate strength ICS into MART

Step 5: increase strength to high strength ICS or initiate (specialist)
Such as clenil 250mg
- theophylline
-tiotropium
Oral corticosteroid like prednisalone
- monoclonal antibodies

20
Q

What is the low dose for an inhaled corticosteroid for beclametasone

A

100mg 2 puff BD

21
Q

Name some inhaled corticosteroid used in asthma

A

Beclometasone
Budesonide
Ciclesonide
Fluticasone
Mometasone

22
Q

What is the only LTRA

A

Montelukast

23
Q

What is the asthma treatment pathway for children over 5

A

Step 1: intermittent reliever (SABA)

Step 2: SABA + regular preventer (ICS)- very low strength (paediatric) eg clenil 50mcg 2puffs a day twice a day
- start ICS if asthma is uncontrollable by SABA alone (use SABA 3x a week, symptoms 3x a week, night time awakening at least once a week, using >1 inhaler per month)

Step 3: SABA + ICE+
- LTRA
-LABA: if aged 12+

Step 4: Replace LTRA with LABA if not already on LABA
- can be given as MART (maintenance and reliever therapy) if still no change

Step 5: Increase ICS strength or initiate specialist
-oral corticosteroid
- theophylline
Monoclonal antibodies
- tiotropium (12+)

24
Q

What is the treatment pathway for children under 5

A

Step 1: intermittent reliever (SABA)
- if using more than one device per month- urgent referral

Step 2: SABA + regular preventer (ICS)- very low strength (paediatric) 50 clenil
- start if asthma is uncontrolled by SABA alone (Symptoms 3x a week, night time awakening at least once a week)
- use a paediatric moderate dose for an 8 week trial to see if it works before continuing
- if ICS is not tolerated- an LTRA (montelukast) can be used instead take off the ICS and use the montelukast

Step 3: SABA + ICS + LTRA
-if still not controlled- stop LTRA and refer to specialist

25
Q

What is the dropping down regimen for inhalers

A
  • when asthma has been controlled for at least 3 months

-patients should be regularly reviewed when decreasing treatment

  • patient should be maintained at the lowest possible dose of ICS
    — reduction considered every 3 months- 25-50% each time
26
Q

What are the symptoms of complete control of asthma

A

No daytime symptoms
No night time awakening symptoms
No asthma attacks
No need for rescue medication
No limitations on activity including exercise
Normal lung function (FEV, and/or PEF > 80% predicted or best)
Minimal side effects from treatment.

RESPIRATORY DISEASE AND GENITOURINARY DISEASE TOPIC - PRE REG (10 decks)

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