Asthma

Question 1

What is asthma (definition)?

Answer 1

Chronic inflammatory disease characterised by recurrent attacks of breathlessness and wheezing.

Question 2

LABA work on which aspect of asthma pathophysiology?

Answer 2

The smooth muscle dysfunction.

Question 3

ICS work on which aspect of asthma pathophysiology?

Answer 3

The airway inflammation.

Question 4

Smooth muscle dysfunction in asthma consists of?

Answer 4

Bronchoconstriction
Bronchial hyper-reactivity
Hyperplasia
Inflammatory mediator release

Question 5

What does SIMPLE stand for?

Answer 5

Stop smoking. 
Inhaler technique 
Monitoring
Pharmacotherapy
Lifestyle 
Education

Question 6

What would a young teenager newly diagnosed with asthma typically be prescribed?

Answer 6

Salbutamol Inhaler

ICS (Spacer)

Question 7

What symptoms indicate a high probability of an asthma diagnosis?

Answer 7

Cough
Wheeze
Worse at night
Exercise induced
Family history
Widespread wheeze
Evidence of airway narrowing.

Question 8

What symptoms are likely to indicate a differential diagnosis to asthma?

Answer 8

Cough BUT NO wheeze or SOB. 
Dizzy & lightheaded. 
No airway narrowing
Voice disturbance 
Symptoms with cold only
Chronic productive cough
Cardiac disease

Question 9

Is the nitric oxide breath test useful? How does it work?

Answer 9

No. FeNO in the breath of people with asthma detects lung inflammation.

Question 10

What is the ACT?

Answer 10

Asthma Control Test.

Five Qs that refer to the last 4 weeks.

Question 11

What is salbutamol?

Answer 11

Short acting beta agonist (SABA)

Question 12

What is beclametasone?

Answer 12

It is an ICS.

Question 13

What is a typical low dose ICS?

Answer 13

Beclametasone 100microgram per puff. One puff twice a day: low dose.
Two puffs twice a day: medium dose.

Question 14

What is a LABA?

Answer 14

Either 
Formeterol 
or 
Salmeterol 
Long acting b2 agonists.

Question 15

What is the initial add on therapy to asthma treatment following SABA (sulbutamol) and low dose beclametasone (ICS)?

Answer 15

Inhaled LABA
Formeterol/Salmeterol
Consider using combined low dose ICS and LABA in combined inhaler.

Question 16

Following SABA, ICS (low dose) and LABA what can be added a an additional therapy to the management of asthma?

Answer 16

First of all should consider if no response to LABA - ? stopping it and increasing dose of ICS.

If LABA = benefitting, continue LABA and increase ICS to medium dose.

Can also consider trial of LTRA, LAMA etc.

Question 17

What are the licensing requirements for omalizumab?

Answer 17

Step4/5 asthma 
FEV1<80%
>2 severe exacerbations
\+ve skin prick test or +ve RAST to common aeroallergens. 
IgE >50 and <700iu/ml.

Question 18

What is step 1 asthma treatment?

Answer 18

SABA (blue) PRN

IF more than 3x week or 2x day, need to add in a trialed ICS low dose.

Question 19

What is step 2 of asthma management?

Answer 19

If SABA PRN and low dose ICS is not enough, check inhaler technique etc and then add in a LABA such as salmeterol or formeterol.

Question 20

What is step 3 in asthma management?

Answer 20

If SABA prn, low dose ICS and LABA are not managing patient, increase to a medium dose ICS if they have had some improvement from the low dose ICS. If no ICS benefit then a LAMA or LTRA can be considered instead at this stage.

Question 21

What is step 4 of asthma management?

Answer 21

Patient would be on:
SABA prn, medium dose ICS + LABA.

We can now move to high dose ICS/LABA combo plus SABA prn plus a 4th drug: LAMA, LTRA, Theophylline, B agonist tablet.

Question 22

What is step 5 of asthma management?

Answer 22

Oral corticosteroid.

Question 23

How is an acute asthma attack managed?

Answer 23

1. Nebulised bronchodilators such as salbutamol and ipaptropium if severe, driven by OXYGEN. Mg Sulphate stat one dose IV.
2. Oxygen sats of 94-98%.
3. Hydrocortisone IV stat followed by prednisolone 50mg for 5 days post attack.
4. VTE risk assessed.
5. No antibiotics unless evidence of consolidation on chest x-ray or other signs of infection.