asthma

Question 1

spirometry results in asthma

Answer 1

FEV1- significantly reduced
FVC- normal
FEV1% <70%

Question 2

investigations in asthma

Answer 2

spirometry
FeNO / measure eosinophil count
chest x-ray

Question 3

management of asthma in adults (new diagnosis)

Answer 3

1st line: low-dose ICS/formoterol combination inhaler as needed
2nd line: low-dose MART
3rd line: moderate dose MART
then check FeNO
- consider trial of LTRA or LAMA in addition to moderate dose MART

Question 4

management of acute asthma

Answer 4

admit
oxygen (15L via non-rebreathe mask)
high dose SABA nebulised (and nebulised ipratropium bromide in life threatening)
give first dose of oral prednisolone immediately (continued 5 days after the attack)
IV magnesium sulphate for severe/life-threatening
fail all this: REQUIRE URGENT SENIOR CARE
- intubation and ventilation
- extracorporeal membrane oxygenation

Question 5

features of moderate asthma attack

Answer 5

PEFR 50-75%
speech normal
RR < 25
pulse <110

Question 6

features of severe asthma attack

Answer 6

PEFR 33-50%
can’t complete sentences
RR > 25
pulse > 110

Question 7

features of life-threatening asthma attack

Answer 7

PEFR < 33%
oxygen sats < 92%
normal pCO2
silent chest, cyanosis, feeble respiratory effort
bradycardia
confusion

Question 8

when to titrate down 15L oxygen

Answer 8

when patients are able to maintain SpO 94-98% titrated down to flow rate