Asthma

Question 1

What is it?

Answer 1

Chronic inflammatory condition of the airways characterised by bronchoconstriction

Question 2

What are symptoms of asthma?

Answer 2

Cough, wheezing, chest tightness and SOB

Question 3

What is treatment line for asthma ages 5 and over?

Answer 3

1st line;
SABA- salbutamol

2nd;
Inhaled ICS -
fluticasone/mometasone equal clinical activity to Beclometasone and Budenoside at half dose

3rd; LABA salmaterol, formetrol used in conjunction with ICS

4th line;

LKRA or Theophylline or Beta agonist MR ;
Montelukast

5th line;
add oral regular corticosteroid (lowest tolerated dose)

Question 4

Why should Inhaled ICS be avoided in children where possible?

Answer 4

High doses of ICS can be associated with growth failure, reduced bone mineral density and adrenal suppression.

Question 5

What is treatment of asthma in children under 5?

Answer 5

1st line: SABA
2nd line; Inhaled ICS or LKRA
3rd line; Inhaled ICS or LKRA
4th line; refer to specialist

Question 6

What is treatment in pregnancy and breastfeeding?

Answer 6

All the same as adult treatment.

LKRA has limited information on pregnancy so used if risks outweighs benefits.

Important to achieve good asthma control, if this is achieved it has no important effects on pregnancy, labour or the foetus.

Question 7

What is treatment if exercise is a specific problem?

Answer 7

If already taking ICS, consider adding LKRA, LABA, oral Beta 2 antagonist, sodium cromoglicate, theophylline.

Question 8

ACUTE ASTHMA:
What is management acute asthma attack?

Answer 8

1st; high dose SABA ASAP

adequate dose of prednisolone once daily for 5 days or until recovery.

if non-life threatening- a pMDI with spacer is preferred
if Life threatening- beta-2 agonist given by oxygen-driven nebuliser

Question 9

ACUTE ASTHMA:

What is given to patient with severe acute asthma and why?

Answer 9

To ALL patients with severe acute asthma;
supplementary oxygen to maintain spO2 levels between
94-98%

Nebulised ipatropium bromide may be combined with nebulised beta2 agonist- this provides greater bronchodilation

Question 10

ACUTE ASTHMA:
What element can be used as a bronchodilator?

Answer 10

Magnesium sulphate

Question 11

What are examples of bronchodilators?

Answer 11

SABA
LABA
Oral beta 2 agonist

Question 12

What bronchodilators are safest and most effective in asthma?

Answer 12

Salbutamol

Question 13

What bronchodilators are least safe and why?

Answer 13

Ephedrine, they are least selective and therefore more likely to cause arrhythmias and other side effects

Question 14

What bronchodilator is best for nocturnal asthma?

Answer 14

LABA

Question 15

What bronchodilators should NOT be used in acute asthma attacks?

Answer 15

Salmeterol due to its slower onset of action

Question 16

what is formeterol and what is it used for ?

Answer 16

A LABA
licensed for short term symptom relief and for prevention of exercise induced bronchospasm.

Question 17

What are the two types of antimuscarinic bronchodilator, how do they differ?

Answer 17

ipatropium bromide
This is a SAMA, max effects occurs in 30-60mins and duration is 3-6 hours

bronchodilator can be maintained by TDS doses.
Tiotropium;
LAMA
used with ICS and LABA for patients who have experienced 1 or more exacerbation in the last year.

Question 18

What are common side effects of antimuscarinic bronchodilators?

Answer 18

Dry mouth and glaucoma

Question 19

How long is salbutamol duration of action?

Answer 19

3-5 hours

Question 20

What side effects of salbutamol?

Answer 20

muscle cramps
hypokalaemia ( with high doses)

Question 21

What are common interactions with salbutamol?

Answer 21

Increased risk of hypokalaemia when given with theophylline or prednisolone.

Question 22

What are monitoring requirements of salbutamol?

Answer 22

uncomplicated premature labour; monitor blood pressure, pulse rate (should not exceed 120 beats per minute), ECG (discontinue treatment if signs of myocardial ischaemia develop), blood glucose and lactate concentrations, and the patient’s fluid and electrolyte status

Question 23

What are side effects of ALL Beta-2 agonist?

Answer 23

Arrhythmias; headache; palpitations; tremor

hyperglycaemia but uncommon

Question 24

What are monitoring requirements of all selective beta-1 agonists?

Answer 24

hypokalaemia

gylcaemia