asthma

Question 1

New Asthma classifications

Answer 1

Intermittent (infrequent or frequent)

Persistent (Mild, moderate, severe)

Question 2

What are asthma classifications based on?

Answer 2

frequency of symptoms

Question 3

Difference between intermittent and persistent asthma?

Answer 3

Persistent asthma has:

• daytime symptoms 1x/ week

OR

• night time symptoms 1x/ 2 weeks

Question 4

Difference between infrequent intermittent asthma and frequent intermittent asthma?

Answer 4

Infrequent less than every 6 weeks, frequent occurs at least every 6 weeks

Question 5

Criteria for moderate persistent asthma?

Answer 5

Any of:

• FEV < 80
• Daily daytime symptoms
• weekly night time symptoms

Question 6

Criteria for severe persistent asthma?

Answer 6

Any of:

• FEV <60
• constant daytime symptoms
• frequent night time symptoms
• frequent flare-ups
• activity/ sleep constantly interrupted by symptoms

Question 7

Asthma Relievers

Answer 7

Beta 2 agonists

• sulbutamol (ventolin etc)
• turbutaline

Anticholinergics

• ipratropium bromide (atrovent) (for status asthmaticus)

Question 8

Asthma Preventers

Answer 8

Leukotriene antagonists

• montelukast (singulair)

Mast Cell stabilisers

• Intal

ICS

• fluticasone, beclamethasone, budosenide

Question 9

Asthma Symptom Controllers?

Answer 9

LAB2As

• salmeterol

LABA + ICS

• seretide (fluticasone + salmeterol)
• symbicort (budosenide + eformoterol)

Question 10

Initial regular treatment for Infrequent Intermittent asthma?

Answer 10

none,

salbutamol PRN

Question 11

Initial regular treatment for Frequent Intermittent asthma? (in children)

Answer 11

maybe montelukast (in children)

Question 12

Initial regular treatment for persistent asthma?

Answer 12

ICS

consider trialing montelukast beforehand if only mild

Question 13

What counts as good asthma control?

Answer 13

No night time symptoms or limitation to activities.

<2/week they have daytime symptoms/ need to use reliever

Question 14

What counts as partial asthma control?

Answer 14

Any of:

• limitation to activities
• nightime symptoms
• daytime symptoms/ need for releiver >2 times/ week

Question 15

What counts as poor asthma control?

Answer 15

daytime symptoms > 2 times/ week lasting for > a few minutes,

> 2 of the features of partial control

Question 16

The treatment all chilren with asthma should receive?

Answer 16

Salbutamol PRN

Question 17

If salbutamol PRN is not adequately controlling symptoms (chronically)?

Answer 17

A regular preventer should be used:

low dose ICS

or

montelukast

or

cromone (sodium cromoglycate)

Question 18

What is the next step if a child’s asthma is not well controlled with salbutamol PRN and a regular preventer?

Answer 18

a stepped up regular preventer

• high dose ICS
• ICS + montelukast
• ICS/ LABA combo

Question 19

What is the next step if a child’s asthma is not well controlled with salbutamol PRN and a stepped up regular preventer?

Answer 19

referral

Question 20

What are the levels of acute asthma?

Answer 20

mild/ moderate

severe

life threatening

Question 21

When would you consider a child with acute asthma to have mild/ moderate severity?

Answer 21

Can walk and speak whole sentences in one breath.

Question 22

When would you consider a child with acute asthma to have severe severity?

Answer 22

Use of accessory muscles

Can’t complete sentences (in 1 breath)

Respiratory distress

O2 sats 90-94%

Question 23

When would you consider a child with acute asthma to have life threatening severity?

Answer 23

Cognition affected

Exhaustion

Cyanosis

Sats <90%

Poor resp effort

Question 24

Acute Athma Flare-up Protocol

Answer 24

Salbutamol

Systemic Steroids

Atrovent (ipratropium bromide)

+/- IV hydrocortisone, IV salbutamol, IV MgSO4, PICU, PPV

• intubate

Question 25

What is status asthmaticus?

Answer 25

Acute severe asthma that does not respond to standard treatments (bronchodilators and steroids)