Asthma

Question 1

what are the 3 levels of acute asthma?

Answer 1

moderate, severe, life threatening

Question 2

what is described as moderate acute asthma? peak flow, speech, SpO2, respiratory rate?

Answer 2

-peak flow >50
-able to complete full sentences
-SpO2 >92%
-respiratory rate < than or equal to 30 (children 5+)
< than or equal to children 1-5

Question 3

what is described as severe acute asthma? peak flow, speech, SpO2, respiratory rate, heart rate

Answer 3

-peak flow 33-50%
-unable to complete full sentences
-respiratory rate > or equal to 25 (adults), >30 (children 5+), >40 children 1-5
-heart rates >125 bpm children 5+, >140 bpm children 1-5

Question 4

what is described as life-threatening acute asthma? peak flow, speech, SpO2, respiratory rate?

Answer 4

-peak flow <33%
-Spo2 <92%
-CYANOSIS
-silent chest
-altered consciousness
-hypotension
-exhaustion

Question 5

what is the management for acute asthma in adults?

Answer 5

-moderate: home or primary care if not go to hospital if not adequate response. treatment high dose SABA via PMI and spacer
-severe or life threatening: hospital immediately. tREATMENT HIGH DOSE SABA (salbutamol 8-10 puffs) via oxygen-driven nebuliser +/-nebulised ipratoprium
-near-fatal or life threatening with a poor reposes to initial therapy: IV amiophylline

Question 6

what is acute asthma?

Answer 6

like an asthma attack

Question 7

what is all patients given after an asthma attack?

Answer 7

-all patient: oral prednisolone for 5 days - if inappropriate, IV hydrocortisone or IM methylpredisonsole

Question 8

what happens if the patients are hyperaemic?

Answer 8

supplementary oxygen (maintain SpO2 between 94-98%)

Question 9

what is management for acute asthma for children?

Answer 9

2 years and over= severe or life threatening should go hospital immediately (oxygen in life threatening acute asthma or Spo2 <94%)
-first line SABA salbutamol
~mild to moderate: PMI and space medical attention need if symptoms not controlled with up to 10 puffs
Severe or life threatening: via an oxygen-driven nebuliser

Question 10

what is given to all children fir acute asthma?

Answer 10

3 days oral prednisolone

Question 11

what is given if there is poor initial response to beta2 agonist?

Answer 11

: add nebulised ipratrioum

Question 12

what is first line for poor response?

Answer 12

IV MAGNEISUM SULFATE

Question 13

WHAT IS THE TREATMENT FOR ACUTE ATHMA IN UNDER 2YEARS?

Answer 13

-all children should go to hospital
-moderate and severe: immediate oxygen + trial a SABA
-if needed combine nebulised ipratropium bromide

Question 14

what are some lifestyle changes for chronic asthma?

Answer 14

-weight loss if overweight
-smoking cessation
breathing exercise programme

Question 15

what is the treatment for chronic asthma IN ADULTS?

Answer 15

step 1: intermittent reliever (SABA)
STEP 2: SABA + low dose regular preventer (ICS)= start ICS if asthma is uncontrolled with SABA only. (Use SABA 3x a week, symptoms 2 a week, night time awakening at least once a week, using >1 inhaler per month)
Step 3: LTRA (NICE), LABA (BTS/SIGN)= fixed dose or as MART
STEP 4: Add LABA with or without LTRA (nice). Can also add LABA + moderate strength ICS into MART
step 5: INCREASE strength to high strength ics OR INITIATE (SPECIALIST)= THEOPHYLLINE, TIOTRIPIUM, ORAL CORTICOSTERIODS, MONOCOLONICAL ANTIBODIES

Question 16

what is the low dose of ICS?

Answer 16

beclometasone (clonal)
100mg 2 puffs twice a day

Question 17

WHAT IS THE TREATEMTN FOR CHRONIC ASTHMA IN CHILDREN over 5?

Answer 17

step 1: intermittent reliever (SABA)
STEP 2: SABA + very low dose regular preventer (ICS)= start ICS if asthma is uncontrolled with SABA only. (Use SABA 3x a week, symptoms 2 a week, night time awakening at least once a week, using >1 inhaler per month)
Step 3: LTRA (NICE), LABA (BTS/SIGN)= IF aged 12+
STEP 4: REPLACE LTRA with LABA if not already on LABA, can be given as MART if not change
STEP 5: increase ICS STRENGTH OR INITATE SPECIALIST: ORAL CORTICOSTERIOD, THEOPHYLLINE, MONOCLONAL ANITIBODIES, TIOTROPIUM (12+)

Question 18

what strength is the strength of the ICS in children?

Answer 18

clenil 50mcg 2 puffs twice a day

Question 19

what is the treatment for chronic asthma for children under 5?

Answer 19

step 1: intermittent reliever (SABA), if using more than 1 device per month urgent referral
STEP 2: SABA + regular preventer (ICS) -VERY LOW STRENGTH (paediatric)= start if asthma is uncontrolled with SABA alone and symptoms . use paediatric low dose for an 8 week trial to see if it works before continuing. if ICS not tolerated- an LTRA (montelukast) used instead.
step 3: SABA +ICS+ LTRA. if not controlled stop LTRA and refer to specialist

Question 20

the. can you drop down from asthma treatment?

Answer 20

-when asthma has been for at least 3 months
-patients should be regularly reviewed when decreasing treatment
-patient should be maintained at the lowest possible dose of ICS, reductions considered every 3 months 25-30% each time

Question 21

what is complete control?

Answer 21

-no day time symptoms
-no night time awaking
-no asthma atatcks
-no need for rescue medication
-no limitations on activity including exercise
-normal lung function (FEV1 and /or PEF >80% predicted or best
-minimal SE from treatment