Asthma

Question 0

What are the symptoms of asthma?

Answer 0

Wheeze
Breathlessness
Chest tightness
Cough

These are worse at night and in early morning
Present in response to exercise, allergens, cold air
Present after taking aspirin and beta blockers

Question 1

What are risk factors for the development of asthma?

Answer 1

Atopy
Family history
Obesity
Smoking
Maternal smoking
Viral infections in early childhood

Question 2

What investigations can be performed if the diagnosis of asthma is uncertain?

Answer 2

If high probability of asthma, trial of treatment!

Otherwise:
Assess change in FEV1 and PEF to inhaled bronchodilator - spirometry
Test atopic status
Test bronchial hyper-responsiveness with methacholine, exercise or mannitol

In adults, if fev1/FVC is <0.7, consider trial of treatment

Question 3

How often should patients with inhalers for asthma be reviewed?

Answer 3

Review every three months

If control achieved, stepwise reduction in dose

Question 4

When is self management used in treating asthma?

Answer 4

Offer self-management to all patients!

Include a written personalised action plan

This should be supported with regular professional review

Question 5

What are the steps for management of asthma in an adult?

Answer 5

1. Short acting beta agonist as req
2. Add in inhaled steroid (400mcg)
3. Add in long acting beta agonist
4. Consider increasing steroid dose (max 2000mcg) or adding in theophylline/leukotriene
5. Daily steroid tablet

Question 6

What are the steps for asthma management in a 5-12 year old?

Answer 6

1. SABA
2. Inhaled steroid 200mcg
3. Add LABA
4. Increase inhaled steroid - max 800mcg
5. Daily steroid tablet / refer to paeds

Question 7

What are the steps to asthma management in under 5s?

Answer 7

1. SABA
2. Inhaled steroid 200-400mcg a day
3. Add leukotriene receptor agonist
4. Refer to paeds

Question 8

What are examples of short acting beta agonists?

Answer 8

Serbutamol

Terbutaline

Question 9

How should short acting beta agonist be used?

Answer 9

Up to once daily
Re assess if needed more than twice a week or at night

Inhale before exertion to relieve exercise induced asthma

Consider spacer

Question 10

What are side effects of salbutamol?

Answer 10

Fine tremor
Headache
Palpitations
Tachycardia
Bronchospasm
Hypokalaemia

Question 11

What are some examples of an inhaled corticosteroid?

Answer 11

Beclometasone
Budesonide
Fluticasone

Question 12

How should inhaled corticosteroids be used?

Answer 12

Must be used regularly for maximum benefit

Wash mouth out afterwards to prevent infection

If stepping down, reduce dose slowly

Question 13

What are side effects of inhaled corticosteroids?

Answer 13

Hoarse voice
Thrush
Paradoxical bronchospasm
Adrenal suppression
LRTI

Question 14

What are some long acting beta 2 agonists?

Answer 14

Serovent (salmeterol)

Foradil (formeterol)

Question 15

How are long acting beta agonists used?

Answer 15

Useful in nocturnal asthma

Initiated in low dose initially and monitored before increase

Discontinued in the absence of benefit

Question 16

What are some leukotriene receptor antagonists?

Answer 16

Montelukast

Zafirlukast

Question 17

What are the side effects if leukotriene receptor antagonists?

Answer 17

Churrg- Strauss syndrome - diffuse Vasculitis disease
Abdominal pain
Thirst
Dry mouth

Question 18

What is theophylline?

Answer 18

A xanthine bronchodilator

Taken as a tablet

Question 19

What are the side effects of theophylline?

Answer 19

Nausea
Vomiting
Abdominal pain
Thirst
Dry mouth

Question 20

What are the side effects of oral steroids?

Answer 20

Bruising
Weight gain
Stomach irritation
Mood changes
Osteoporosis
Fractures

Question 21

What are some starting doses of corticosteroids for under fives, 5-12 and adults?

Answer 21

Under 5s: 200 mcg
5-12: 300-400 mcg
Adults: 400-500 mcg