ASTHMA

Question 0

Adverse effects of LABA?

Answer 0

Oral candidiasis
Osteoporosis
Stunted growth (controversial)

Question 1

How do you diagnose asthma?

Answer 1

Hx + Exam
Ruling out differential
Greater than >12% change following bronchodilator.

Question 2

What do you do if a patient has asthma attack not responding?

Answer 2

Technique used
Adherence
Diagnosis confirmed

Question 3

Complications of asthma?

Answer 3

Status asthmaticus

Pneumothorax

Question 4

What history features?

Answer 4

Wheeze, chest tightness, cough 
Recurrent/seasonal 
Worse at night/early morning
Hx of allergies (asthma hayfever) 
FHx
Reduced FEV1/pefr

Relief rapidly after bronchodilator

Question 5

Principles of management?

Answer 5

Give everyone with symptomatic asthma a SABA.

Give preventers to those with flare ups or night time symptoms

Preventer use should be started with low dose ICS (titrated to lowest possible dose)
If moderate or severe persistent asthma -> add LABA and decrease ICS

Question 6

What is good control?

Answer 6

<2d/week of symptoms and SABA requirement

Question 7

What are relievers? MOA? SE?

Answer 7

SABA - salbutamol

Stimulate b2 receptors -> bronchodilation

Tremor, tachycardia and headaches

Ipratropium bromide (more COPD) 
Theophylline (severe)

Question 8

What are preventers MOA? Types? SE?

Answer 8

Anti inflammatory properties, if taken regularly decrease symptoms and Exacerbations.

ICS

• fluticasone, beclamethasone, budenoside
• SE: dose related, if high -> risk of cataracts, reduced BMD, OP, glaucoma and skin bruising
• titrate daily dose

Leukotriene Receptor Antagonists
- montelukast/singulair

Question 9

What are symptom controllers?

Answer 9

LABAs

• produce long term control up to 12 hours
• salmeterol. Eformoterol
• taken on regular basis with ICS

Question 10

What are standard combinations given?

Answer 10

Seretide: fluticasone and salmeterol
- delayed onset of action, not used as reliever but maintenance

Symbicort: budesonide and eformeterol
- rapid onset of action, can be used as reliever and medication

Question 11

How do you manage mild-moderate asthma acutely?

Answer 11

Immediately -> Give 4-12 puffs salbutamol via spacer.

Within minutes -> reassess severity, continue bronchodilator every 20-30, if poor add ipratropium bromide.

Within first hour start also systemic corticosteroids

Reassess after 1 hour since bronchodilator and observe 1 hour after SOB relieved

Question 12

How do you manage severe asthma attack?

Answer 12

02 90-94%, WOB, unable to speak sentences

Give 12 puff via spacer OR if can’t breathe through spacer neb, start O2

Within minutes continue 8 puffs bronchodilator ever 20 minutes OR give neb 500mcg salbutamol

ORAL PRED 37.5-50mg continue 5-10days. If oral NOT POSSIBLE hydrocortisone IV

If persists arrange hospital admission

Question 13

Management of life threatening asthma?

Answer 13

Drowsy, collapsed, exhausted, Cyanotic 02< 90%

Give 2*5 mg nebules salbutamol via cont neb. Start O2.

TRANSFER IMMEDIATELY HIGH CARE

CONTINUE BRONCHIDILATOR VIA NEB

CONSIDER SWITCH TO SPACER 8 puffs

Within first hour give 37.5-50 mg PRED
CONT 5-10 days

TRANSFER TO ICU IF PERSISTS