Asthma

Question 1

What questions have to ask in the history in asthma?

Answer 1

Occupation
Pets and allergy
Atopy history - eczema, other rashes etc.
Diurnal variation 
Impact on daily living and function

Question 2

Describe stepwise management of asthma in under 5 year old

Answer 2

1. SABA
2. • ICS, consider leukotriene antagonist LKA(montelukast) if unwilling to take
3. Increase ICS, Refer if under 2; + LKA if not already
4. Refer

Question 3

Stepwise management of asthma in 5-12 year old and over 12 year old are similar, although doses differ. Describe the steps…

Answer 3

1. SABA
2. • ICS
3. • LABA, if no change, consider LKRA or theophylline
4. Increase ICS dose and add adjuncts not already tried
5. Oral steroid (lowest dose providing adequate control) & refer to either paediatrician or respiratory specialist

Question 4

Max ICS dose for Each age group?

Answer 4

0-2 400 ug
2-5 400 ug
5-12 800 ug
>12 2000 ug

Question 5

What does stepwise management mean in asthma care?

Answer 5

Start patient at appropriate level depending on symptoms and what required to control them.
Move patient up step if still failing to control
Maintain on lowest step that provides good control

Question 6

How do you manage acute asthma attack?

Answer 6

OSHITMAN
Oxygen
Salbutamol + Ipratropium nebs
Hydrocortisone (or prednisolone)
Magnesium sulphate
Senior involvement - anaesthetis etc
Consider theophylline