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Year 6 Respiratory > Asthma > Flashcards

Asthma Flashcards

1
Q

What is acute asthma?

A

Acute asthma is nearly always seen in patients who’ve got a history of asthma.

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2
Q

What are the features of acute asthma?

A

Worsening dyspnoea, wheeze and cough that is not responding to salbutamol. It may be triggered by a respiratory tract infection.

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3
Q

How are patients with acute severe asthma stratified?

A

Patients are stratified into moderate, severe, or life-threatening categories.

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4
Q

What are the characteristics of moderate acute asthma?

A

PEFR 50-75% best or predicted, speech normal, RR < 25/min, pulse < 110 bpm.

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5
Q

What are the characteristics of severe acute asthma?

A

PEFR 33-50% best or predicted, can’t complete sentences, RR > 25/min, pulse > 110 bpm.

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6
Q

What are the characteristics of life-threatening acute asthma?

A

PEFR < 33% best or predicted, oxygen sats < 92%, silent chest, cyanosis or feeble respiratory effort, bradycardia, dysrhythmia or hypotension, exhaustion, confusion or coma.

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7
Q

What does a normal pCO2 indicate in an acute asthma attack?

A

A normal pCO2 indicates exhaustion and should be classified as life-threatening.

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8
Q

PEFR, speech, RR, pulse

A
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9
Q

What are the categories of acute asthma according to the British Thoracic Society (BTS)?

A

The categories are moderate, severe, and life-threatening.

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10
Q

What are the characteristics of moderate acute asthma?

A

PEFR 50-75% best or predicted, speech normal, RR < 25/min, pulse < 110 bpm.

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11
Q

What are the characteristics of severe acute asthma?

A

PEFR 33-50% best or predicted, can’t complete sentences, RR > 25/min, pulse > 110 bpm.

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12
Q

What are the characteristics of life-threatening acute asthma?

A

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.

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13
Q

What should be done if a patient has any life-threatening features?

A

They should be treated as having a life-threatening attack.

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14
Q

What is ‘Near-fatal asthma’ characterized by?

A

‘Near-fatal asthma’ is characterized by a raised pC02 and/or requiring mechanical ventilation with raised inflation pressures.

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15
Q

What does the BTS recommend for further assessment in patients with oxygen sats < 92%?

A

Arterial blood gases should be assessed.

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16
Q

When is a chest x-ray recommended?

A

A chest x-ray is recommended for life-threatening asthma, suspected pneumothorax, or failure to respond to treatment.

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17
Q

What is the admission criteria for patients with life-threatening asthma?

A

All patients with life-threatening asthma should be admitted to the hospital.

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18
Q

What should be done for hypoxaemic patients?

A

Start supplemental oxygen therapy.

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19
Q

What is the initial oxygen therapy for acutely unwell patients?

A

Start on 15L of supplemental oxygen via a non-rebreathe mask, titrated down to maintain SpO2 94-98%.

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20
Q

What is the recommended bronchodilation treatment for acute asthma?

A

High-dose inhaled SABA (e.g., salbutamol, terbutaline).

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21
Q

How should SABA be administered in patients without life-threatening features?

A

SABA can be given by a standard pressurised metered-dose inhaler (pMDI) or by an oxygen-driven nebulizer.

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22
Q

What is the recommended treatment for patients with life-threatening exacerbation of asthma?

A

Nebulised SABA is recommended.

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23
Q

What corticosteroid should all patients receive?

A

All patients should be given 40-50mg of prednisolone orally daily for at least five days.

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24
Q

What additional treatment can be considered for severe or life-threatening asthma?

A

Nebulised ipratropium bromide may be used if there is no response to beta-agonist and corticosteroid treatment.

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25
Q

What does the BTS say about IV magnesium sulphate?

A

The evidence base is mixed, but it is commonly given for severe/life-threatening asthma.

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26
Q

What should be done for patients who fail to respond to treatment?

A

They require senior critical care support and should be treated in an appropriate ITU/HDU setting.

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27
Q

What are the criteria for discharge from the hospital?

A

Patients must be stable on discharge medication for 12-24 hours, inhaler technique checked, and PEF > 75% of best or predicted.

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28
Q

What SpO2 level indicates a severe asthma attack in children?

A

SpO2 < 92%

Unlike in adults, SpO2 < 92% may be consistent with a ‘severe’ attack in children.

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29
Q

What is the PEF range for a severe asthma attack in children?

A

PEF 33-50% best or predicted

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30
Q

What are the signs of a severe asthma attack related to communication?

A

Too breathless to talk or feed

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31
Q

What is the heart rate threshold for a severe asthma attack in children over 5 years?

A

Heart rate >125

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32
Q

What is the heart rate threshold for a severe asthma attack in children aged 1-5 years?

A

Heart rate >140

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33
Q

What is the respiratory rate threshold for a severe asthma attack in children over 5 years?

A

Respiratory rate >30 breaths/min

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34
Q

What is the respiratory rate threshold for a severe asthma attack in children aged 1-5 years?

A

Respiratory rate >40 breaths/min

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35
Q

What physical sign indicates a life-threatening asthma attack?

A

Use of accessory neck muscles

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36
Q

What is the PEF level for a life-threatening asthma attack?

A

PEF <33% best or predicted

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37
Q

What are some signs of a life-threatening asthma attack?

A

Silent chest, Poor respiratory effort, Agitation, Altered consciousness, Cyanosis

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38
Q
A
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39
Q

What SpO2 level indicates a severe asthma attack in children?

A

SpO2 < 92%

Unlike in adults, SpO2 < 92% may be consistent with a ‘severe’ attack in children.

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40
Q

What is the PEF range for a severe asthma attack in children?

A

PEF 33-50% best or predicted

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41
Q

What are the signs of a severe asthma attack related to communication?

A

Too breathless to talk or feed

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42
Q

What is the heart rate threshold for a severe asthma attack in children over 5 years?

A

Heart rate >125

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43
Q

What is the heart rate threshold for a severe asthma attack in children aged 1-5 years?

A

Heart rate >140

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44
Q

What is the respiratory rate threshold for a severe asthma attack in children over 5 years?

A

Respiratory rate >30 breaths/min

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45
Q

What is the respiratory rate threshold for a severe asthma attack in children aged 1-5 years?

A

Respiratory rate >40 breaths/min

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46
Q

What physical sign indicates a life-threatening asthma attack?

A

Use of accessory neck muscles

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47
Q

What is the PEF level for a life-threatening asthma attack?

A

PEF <33% best or predicted

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48
Q

What are some signs of a life-threatening asthma attack?

A

Silent chest, Poor respiratory effort, Agitation, Altered consciousness, Cyanosis

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49
Q

Assessment of acute attacks in children aged 2-5, and in > 5: moderate, severe, life-threatening

A
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50
Q

Pred doses in children

A
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51
Q

What should be done for children with severe or life-threatening asthma?

A

They should be transferred immediately to hospital.

52
Q

What are the indicators of a moderate asthma attack in children aged 2-5?

A

SpO2 > 92% and no clinical features of severe asthma.

53
Q

What are the indicators of a severe asthma attack in children aged 2-5?

A

SpO2 < 92%, too breathless to talk or feed, heart rate > 140/min, respiratory rate > 40/min, use of accessory neck muscles.

54
Q

What are the indicators of a life-threatening asthma attack in children aged 2-5?

A

SpO2 < 92%, silent chest, poor respiratory effort, agitation, altered consciousness, cyanosis.

55
Q

What should be attempted for children greater than 5 years of age during an asthma attack?

A

Attempt to measure PEF in all children aged > 5 years.

56
Q

What are the indicators of a moderate asthma attack in children aged > 5?

A

SpO2 > 92% and PEF > 50% best or predicted with no clinical features of severe asthma.

57
Q

What are the indicators of a severe asthma attack in children aged > 5?

A

SpO2 < 92%, PEF 33-50% best or predicted, can’t complete sentences in one breath or too breathless to talk or feed, heart rate > 125/min, respiratory rate > 30/min, use of accessory neck muscles.

58
Q

What are the indicators of a life-threatening asthma attack in children aged > 5?

A

SpO2 < 92%, PEF < 33% best or predicted, silent chest, poor respiratory effort, altered consciousness, cyanosis.

59
Q

What is the treatment for children with mild to moderate acute asthma?

A

Bronchodilator therapy using a beta-2 agonist via a spacer, with 1 puff every 30-60 seconds up to a maximum of 10 puffs.

60
Q

What should be done if symptoms are not controlled in children with acute asthma?

A

Repeat beta-2 agonist and refer to hospital.

61
Q

What steroid therapy should be given to children with an asthma exacerbation?

A

Steroid therapy should be given for 3-5 days.

62
Q

What is the usual prednisolone dose for children aged 2-5 years?

A

20 mg od or 1-2 mg/kg od (max 40mg).

63
Q

What is the usual prednisolone dose for children older than 5 years?

A

30 - 40 mg od or 1-2 mg/kg od (max 40mg).

64
Q

What organizations produced joint guidelines on asthma management in 2024?

A

NICE, the British Thoracic Society, and SIGN.

65
Q

What are the first-line investigations for suspected asthma in adults according to NICE?

A

Measure the eosinophil count OR fractional nitric oxide (FeNO).

66
Q

When can asthma be diagnosed without further investigations in adults?

A

If eosinophil count is above the reference range or FeNO is ≥ 50 ppb.

67
Q

What is the criterion for diagnosing asthma using bronchodilator reversibility (BDR) in adults?

A

FEV1 increase is ≥ 12% and 200 ml or more from the pre-bronchodilator measurement, or FEV1 increase is ≥ 10% of the predicted normal FEV1.

68
Q

What should be measured if spirometry is not available for adults suspected of asthma?

A

Measure peak expiratory flow (PEF) twice daily for 2 weeks.

69
Q

What indicates asthma diagnosis based on PEF variability in adults?

A

PEF variability (amplitude percentage mean) is ≥ 20%.

70
Q

What should be done if asthma is still suspected in adults after initial tests?

A

Refer for consideration of a bronchial challenge test.

71
Q

What is the first-line investigation for suspected asthma in children aged 5 to 16?

A

Measure the fractional nitric oxide (FeNO).

72
Q

When can asthma be diagnosed in children aged 5 to 16 based on FeNO?

A

If FeNO is ≥ 35 ppb.

73
Q

What should be done if FeNO testing is not available for children aged 5 to 16?

A

Measure bronchodilator reversibility (BDR) with spirometry.

74
Q

What indicates asthma diagnosis based on PEF variability in children aged 5 to 16?

A

PEF variability (amplitude percentage mean) is ≥ 20%.

75
Q

What tests can be performed if asthma is not confirmed in children aged 5 to 16?

A

Perform skin prick testing to house dust mite OR measure total IgE level and blood eosinophil count.

76
Q

What indicates asthma diagnosis based on sensitization in children aged 5 to 16?

A

Evidence of sensitization OR a raised total IgE level and eosinophil count > 0.5 x 10^9/L.

77
Q

What should be done if there is doubt about asthma diagnosis in children aged 5 to 16?

A

Refer to a paediatric specialist for a second opinion.

78
Q

What is the guideline for investigating asthma in children under 5?

A

Treat with inhaled corticosteroids and review regularly.

79
Q

When should objective tests be attempted for children under 5?

A

If they still have symptoms at age 5.

80
Q

What is the recommendation for preschool children with frequent wheeze?

A

Refer to a specialist respiratory paediatrician.

81
Q

What role do eosinophils play in asthma?

A

Eosinophils are involved in type 2 inflammation and airway inflammation.

82
Q

How is fractional exhaled nitric oxide (FeNO) measured?

A

By having the patient exhale into a handheld device that analyzes nitric oxide concentration in ppb.

83
Q

What does bronchodilator reversibility (BDR) testing evaluate?

A

The degree of airflow limitation that improves after bronchodilator administration.

84
Q

What does peak expiratory flow (PEF) variability reflect?

A

Diurnal changes in airway calibre, a hallmark of asthma.

85
Q

What role does immunoglobulin E (IgE) play in allergic asthma?

A

IgE mediates hypersensitivity reactions leading to airway inflammation.

86
Q

Why is skin prick testing for house dust mite performed?

A

It identifies a common trigger for asthma in atopic individuals.

87
Q

What does the bronchial challenge test assess?

A

Airway hyper-responsiveness characteristic of asthma.

88
Q

Adult with a history suggesting asthma -diagnosis objective tests

A
89
Q

Children with a history suggesting asthma -diagnosis objective tests

A
90
Q

What do the 2024 NICE guidelines represent in asthma management?

A

A major step change in the management of asthma diagnosis and treatment.

91
Q

What was the traditional treatment approach for asthma?

A

Starting with a short-acting beta-2 agonist (SABA) inhaler before stepping up to a regular inhaled corticosteroid with SABA as needed.

92
Q

What do the new guidelines advocate for reliever therapy?

A

The use of combined inhalers (ICS + long-acting beta-2 agonist) as reliever therapy or regularly, depending on severity.

93
Q

What is the first step in managing adults aged ≥ 12 years with newly diagnosed asthma according to NICE?

A

A low-dose inhaled corticosteroid (ICS)/formoterol combination inhaler to be taken as needed for symptom relief.

This is termed anti-inflammatory reliever (AIR) therapy.

94
Q

What should be done if a patient presents with severe exacerbation or regular nocturnal waking?

A

Start treatment with low-dose MART (maintenance and reliever therapy) and treat acute symptoms appropriately.

95
Q

What does MART stand for?

A

Maintenance and reliever therapy.

96
Q

What is the second step in asthma management according to NICE?

A

A low-dose MART for daily maintenance therapy and relief of symptoms as needed.

97
Q

What is the third step in asthma management?

A

A moderate-dose MART.

98
Q

What should be checked at step 4 of asthma management?

A

The fractional exhaled nitric oxide (FeNO) level and the blood eosinophil count.

99
Q

What action should be taken if FeNO or eosinophil count is raised?

A

Refer to a specialist in asthma care.

100
Q

What should be considered if neither FeNO nor eosinophil count is raised?

A

A trial of either a leukotriene receptor antagonist (LTRA) or a long-acting muscarinic receptor antagonist (LAMA) in addition to moderate-dose MART.

101
Q

What should be done if control has not improved after trying LTRA or LAMA?

A

Stop the LTRA or LAMA and start a trial of the alternative medicine.

102
Q

When should a patient be referred to a specialist in asthma care?

A

When asthma is not controlled despite treatment with moderate-dose MART and trials of an LTRA and a LAMA.

103
Q

What is the new treatment for patients previously on SABA as required only?

A

Low-dose ICS/formoterol combination inhaler used as needed (as-needed AIR therapy).

104
Q

What should be done for patients on SABA as required + regular low-dose ICS?

A

Switch to a regular low-dose ICS/formoterol combination inhaler (MART therapy).

105
Q

What is the new treatment for patients on a high-dose ICS?

A

Refer to a respiratory specialist.

106
Q

Pharmacological treatment 12yrs+

A
107
Q

What year did NICE, the British Thoracic Society, and SIGN produce joint guidelines on asthma management?

A

2024

108
Q

What is the new recommended reliever therapy for asthma management?

A

Combined inhalers (ICS + long-acting beta-2 agonist) depending on the severity of asthma.

109
Q

What does MART stand for in asthma management?

A

Maintenance and reliever therapy.

110
Q

What is the first step in managing asthma for children aged 5 to 11?

A

Twice-daily paediatric low-dose inhaled corticosteroid (ICS) + short-acting beta2 agonist (SABA) as needed.

111
Q

What is the MART pathway for children whose symptoms are not controlled on the first step?

A

Paediatric low-dose MART + SABA as needed.

112
Q

What should be added if symptoms are still not controlled in the conventional pathway?

A

A leukotriene receptor antagonist (LTRA) to twice daily paediatric low-dose ICS plus SABA as needed.

113
Q

What is the next step if symptoms are still not controlled after adding LTRA?

A

Switch to a twice daily paediatric low-dose ICS/LABA combination inhaler plus SABA as needed.

114
Q

What should be done if children’s asthma symptoms are still not controlled despite treatment?

A

Refer to a respiratory specialist.

115
Q

What is the initial management for children under 5 with asthma?

A

8 to 12 week trial of twice-daily paediatric low-dose ICS as maintenance therapy + SABA as required.

116
Q

What should be considered after the 8 to 12 week trial for children under 5?

A

Stopping ICS and SABA treatment if symptoms are resolved, with a review after a further 3 months.

117
Q

Stepwise treatment - existing and new

A
118
Q

Pharmacological management 12yrs+

A
119
Q

Pharmacological management 5-11yrs

A
120
Q

Pharmacological management under 5s

A
121
Q

MART for children

A
122
Q

What do the British Thoracic Society (BTS) guidelines recommend regarding stepping down asthma treatment?

A

The BTS guidelines recommend considering stepping down treatment every 3 months or so.

123
Q

Do the BTS guidelines advocate a strict move from one treatment step to another?

A

No, the guidelines do not advocate a strict move from one step to another but advise considering duration of treatment, side-effects, and patient preference.

124
Q

How should the dose of inhaled steroids be reduced according to the BTS?

A

The BTS advises reducing the dose of inhaled steroids by 25-50% at a time.

125
Q

How often may patients with stable asthma have a formal review?

A

Patients with stable asthma may only have a formal review on an annual basis.

126
Q

What is likely for patients who have recently had an escalation of asthma treatment?

A

It is likely that they would be reviewed on a more frequent basis.

Year 6 Respiratory (23 decks)

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