Asthma

Question 1

What are the cut-off values for reversibility in spirometry when diagnosing asthma?

Answer 1

Increase in FEV1 >12% AND >200ml (or 10% of predicted normal) after bronchodilatory

Question 2

What is the FENO cut-off used in the diagnosis of asthma?

Answer 2

50ppb

Question 3

If performing a peak flow diary to diagnose asthma, how frequently should measurements be taken and for how long? What is the diagnostic cut off?

Answer 3

Measurements should be twice daily for at least 2 weeks. Diagnose asthma if PEF variability is 20% or more.

Question 4

What is the mechanism of action of Omalizumab (Xolair)? What are the criteria for prescribing? Are there any exclusion criteria?

Answer 4

Anti-IgE. Works by preventing IgE from binding to receptors.
Given as a 2-4 weekly injection.
Used for allergic asthma.
Patient needs to be on MAINTENANCE STEROIDS >=5mg Pred OR >= 4 COURSES of steroids in 12 months AND positive skin prick or raised IgE to perennial aeroallergen
IgE must be between 30 and 700

Question 5

What is the mechanism of Mepolizumab? What are the criteria for prescribing?

Answer 5

Anti IL-5 medication used in eosinophilic asthma.
Need eosinophil count >=0.3, >=4 exacerbations requiring steroids in 12 months or maintenance steroids 5mg Pred or greater over 6 months.
Given via 4-weekly IM injection

Question 6

What is the mechanism of Benralizumab? What are the prescribing criteria?

Answer 6

Anti-IL5 medication used in eosinophilic asthma
Need either Eosinophils >0.4 and >=3 exacerbations needing steroids
OR
Eosinophils >0.3 and >=4 exacerbations needing steroids
OR
Maintenance steroids >= 5mg pred for >6 months

Question 7

What is the mechanism of action of Dupilumab? What are the prescribing criteria?

Answer 7

Treats asthma with T2 inflammation/ rhinosinusitis with polyps/atopic dermatitis
Anti IL-4 and IL-13
Need to have 2 exacerbations requiring steroids or 1 hospital admission with exacerbation
AND
Eosinophils >0.15 AND FeNO >25
AND 4 asthma attacks in 12 months and not suitable for other biologics

Question 8

What is the mechanism of action of Reslizumab? How is it given?
What are the prescribing criteria?

Answer 8

Anti IL-5 given by 4 weekly IV INFUSION.
Eosinophils >=0.4 and >=3 exacerbations requiring oral steroids.
Not available in Scotland

Question 9

What is the mechanism of action of Tezepelumab? What are the prescribing criteria?

Answer 9

Inhibits Thymic Stromal Lymphopoietin (TSLP). Unlike other biologics does not require serum biomarkers.
Patients with >=3 exacerbations requiring PO steroids or those who are on maintenance oral steroids

Question 10

What is the LABA contained in all inhalers approved for MART regimen?

Answer 10

Formeterol- LABA with rapid onset

Question 11

Which antibiotic used in treating pseudomonas can lead to an increase in theophylline levels?

Answer 11

Ciprofloxacin

Question 12

What is the inheritance pattern of alpha-1-antitripsin deficiency?

Answer 12

Autosomal co-dominant
One defective allele results in milder disease than 2 defective alleles

Question 13

Which factors can increase or decrease FeNO measurement?

Answer 13

Increased:
Rhinovirus infection
Males
Taller people

Decreased:
Smokers
Children

Question 14

If a pregnant patient is on regular maintenance prednisolone, what are the best options for delivery?
A) Regular IV hydrocortisone 4-6 hourly during labour
B) IV beta agonists can be used if symptoms during delivery
C) C-section under GA should be advised
4) Prophylactic antibiotics in labour

Answer 14

A is the best option
IV beta agonists should not be used outside of an intensive care setting
GA and intubation increases the risk of bronchoconstriction so should be avoided