asthma

Question 1

what percentage of the population has asthma?

Answer 1

5-8%

Question 2

what is asthma?

Answer 2

REVERSIBLE airway obstruction

Question 3

common three symptoms to aid definition

Answer 3

recurrent episodes of nocturnal cough, audible wheeze and dyspnoea

Question 4

when are most diagnosed?

Answer 4

In infancy

Question 5

triggers

Answer 5

cold air, pollen, animal hair e.g. dog, dust mites,
emotion, exercise, fur, smoking and pollution

rarer- welder and paints, carpet, paint spray, features

Question 6

two meds which may cause it

Answer 6

NSAID

Beta blockers

Question 7

what is a common thing seen and what percentage of pts?

Answer 7

reflux

40-60%

Question 8

trends seen in asthmatics

Answer 8

hay fever
eczema
FH
allergies

Question 9

symptoms and signs

Answer 9

pulse >110 bpm, resp rate >25 bpm

tachypnoea, SOB (Esp at night), tight chest, hyperinflation of chest, hyper-resonant on percussion, audible wheeze,

Question 10

severe asthma -symptoms

Answer 10

silent chest
bradycardia
confusion 
cyanosis
feeble resp effort

Question 11

differentials

Answer 11

Pul oedema, COPD, resp obstruction, bronchiatasis

Question 12

diagnosis

Answer 12

PEF
Spirometry
ABG 
cultures 
X-ray exclude oedema

Question 13

treatment options-1st line and what is It used for?

Answer 13

symptom relief - salbutamol
SABA
as per needed

Question 14

2nd line

Answer 14

inhaled costercosteroid =twice daily

Question 15

3rd

Answer 15

salmetrol - long acting b2 agonist
LABA
or consider leukotriene receptor if no response to LABA

Question 16

what is salbutamol

Answer 16

short acting b2 agonist

Question 17

then what options?

Answer 17

increase iCS to 2000mcg
add fourth drug
steroid tablet with2000MCG inhaled corticosteroid

refer

Question 18

three pathological key steps in asthma

Answer 18

increased mucus production
bronchial muscle contraction
mucosal swelling

Question 19

a key sign in children

Answer 19

WHEEZING

Question 20

last line and what is it

Answer 20

anti igG monoclonal antibody

omalizumab

Question 21

name some examples of steroids used

Answer 21

beclometasone, fluticasone and budesonide

Question 22

what are the steps in paeds under 5

Answer 22

1. SABA
2. ICS
3. Leukotriene or increase ICS
4. refer

Question 23

under 5 dose of ICS

Answer 23

200-400mcg

Question 24

what about steps in 5-12 year

Answer 24

1. saba
2. ics
3. laba , ics to 400mcg or leukotriene if no response
4. increase ics to 800mcg
5. daily steroid tablet, refer to paeds

Question 25

summarise adults

Answer 25

1. saba
2. ics
3. laba, increase dose of ICS, consider leukotriene if no response
4. increase dose of ics to 2000mcg, consider 4th drug
5. steroid tablet and high dose 2000mcg ics
   refer for icu review, amiotrhpyilline and consider intubation

Question 26

adult emergency doses

Answer 26

ipatropoim bromide -500mcg nebs 4-6HRLY 
salbutamol -5mg nebs 15 mins
hydrocortisone 200mg IV
prednisolone 40mg orallyy
magnesium sulphate 2g iv

Question 27

paediatric emergency doses

Answer 27

ipatropium bromide -150ug
prednisolone < 2 year old 10mg, 20 mgg if 2-5, over 5, 30-40. max 60mg
magnesium sulphate 150mcg iv
salbutamol 100mcg 15 mins 2.5mcg nebs