Asthma

Question 1

What is a viral induced wheeze?

Answer 1

Acute wheeze due to viral infection

typically Rhinovirus or RSV

Question 2

What features suggest viral induced wheeze rather than asthma?

Answer 2

Presentation in v young <3 yrs

no atopic history

only during viral infections

Question 3

What is a unilateral wheeze in a child <3yo until proven otherwise?

Answer 3

Foreign object

Question 4

yo

1st line investigation for suspected asthma

Answer 4

Spirometry and bronchodilator reversibility

Question 5

What is the best indicator to diagnose suspected asthma?

Answer 5

FEV1

If there is an improvement of 12% this indicates reversibility with bronchodilator

Question 6

What does a moderate attack look like in a child 2-5?

Can have moderate, severe, lifethreatening

Answer 6

Question 7

What does a moderate attack look like in a child 5+?

Can have moderate, severe, lifethreatening

Answer 7

Question 8

What does a severe attack look like in a child 2-5?

Answer 8

Question 9

What does a severe attack look like in a child 5+

Answer 9

Question 10

What does life threatening attack look like in a child 2-5?

Answer 10

Question 11

What does a life threatening attack look like in a child 5+

Answer 11

Question 12

How to manage oxygen <92%?

Answer 12

High flow oxygen through venturi mask or high flow nasal cannulae

Question 13

If oxygen is not required for management e.g. moderate attack

What can be used?

Answer 13

Bronchodilator burst therapy:

10 puffs salbutamol via MDI and spacer every 30-60 seconds

Need to involve seniors here if burst therapy flopped

Question 14

If a patient has a severe/lifethreatening asthma attack (92% O2>)

Has been given oxygen + bronchodilator burst therapy

what next?

Answer 14

Nebulised salbutamol + Ipratropium bromide

repeat every 20 minutes!

Need to involve seniors here if burst therapy flopped

Question 15

What other bronchodilators can be used as the final line treatment for asthma?

Answer 15

IV

• IV magenisum sulphate (1st)
• IV salbutamol /
• IV aminophylline*

* monitor for hypokalaemia via ECG

Question 16

panic step for asthma attack?

if all else has failed

Answer 16

Intubate and ventilate

Question 17

What to start ALL children who have a asthma attack of any kind?

Answer 17

Oral prednisolone within hour

if they were admitted, then give 3-5 days of oral prednislone for home

Question 18

What counts as being symptom free after a asthma attack?

Answer 18

(don’t need salbutamol for 4 hours) and PEFR >75%. After discharge, follow-up in 48 hours by GP.

Question 19

Asthma management <5yo?

Answer 19

• Step 1 (newly-diagnosed asthma) → SABA.
• Step 2 (not controlled with SABA alone OR symptoms ≥3 times/wk or night-time waking [STRAIGHT TO THIS]) → SABA + 8-Week Trial of Moderate-Dose ICS.
• Step 3 → SABA + ICS + LTRA.
• Step 4 → stop LTRA and refer to paediatric asthma specialist.

Question 20

Asthma management ages 5-16?

Answer 20

• Step 1 (newly-diagnosed asthma) → SABA (salbutamol).
• Step 2 (not controlled with SABA OR symptoms ≥3 times/wk or night-time waking) → SABA + Low-Dose ICS (beclamethasone or budesonide).
  
  • SABA (Blue) → reliever. ICS (Brown) → preventer (twice a day, at morning and night). Always check parents know correct inhaler technique.
• Step 3 → SABA + ICS + LTRA (montelukast).
• Step 4 → SABA + ICS + LABA (salmeterol).

Question 21

How to manage a viral induced wheeze?

Answer 21

• 1st Line → SABA (Salbutamol) utilising ‘Burst Therapy’. Given 10 puffs. Typically given hourly to manage the acute episode.
  • 2nd Line → Oral Montelukast or Inhaled Corticosteroid.