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4th Year CCC > Asthma > Flashcards

Asthma Flashcards

1
Q

Normal expiration:inspiration ratio should be ?

A

2:1

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2
Q

Differentials

A

COPD (less daily/diurnal variation and in smokers)

HF

CHD

Malignancy

GORD

Vocal cord dysfunction

Fibrosis

Recurrent PE

TB

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3
Q

How often should asthma be reviewed?

A

At least annually

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4
Q

What should be asked at an asthma review?

A

Questions:

  1. Do they have difficulty sleeping? (incl cough)
  2. Do they have Sx during the day
  3. Does it interfere with ADL
  4. Any exacerbations in the last year- use of oral steroids and time off work.

Peak flow/spirometry

Inhaler technique

Check adherence and reliance on bronchodilators

Smoking

Flu jab annually

Depression screen

Patient ownership and use of action plan - review and update this if necessary.

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5
Q

What amount of bronchodilator use indicates poor control?

A

> 2 cannisters/month or 10-12 puffs per day indicates poor control, high risk.

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6
Q

What are the four aims of asthma management?

A

Symptom control

Reduce exacerbations and need for rescue meds

Achieve best lung function

Reduce SEs

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7
Q

What are the steps of asthma management?

A
  1. SABA PRN
  2. regular preventer: SABA + ICS
  3. initial add on
  4. additional add on
  5. high dose
  6. continuous or frequent use of oral steroids
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8
Q

> ? doses SABA suggests they might need to step up the ladder?

A

3 per week

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9
Q

What is involved in step 3 initial add on?

A

Keep SABA and ICS

Add LABA (often combination inhaler)

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10
Q

What is involved in step 4 additional add on

A

SABA

LABA didn’t work- stop and consider increasing dose ICS

LABA worked but still inadequate-

a) continue and increase ICS to medium dose
b) continue all and consider trialling others- LTRA, SR theophylline, LAMA

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11
Q

What is involved in step 5 high dose therapies?

A

Trial increasing ICS to high dose or adding a fourth drug e.g. LTRA, SR theophylline, LAMA, beta agonist tablet.

Refer

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12
Q

What is involved in step 6 continuous or frequent use of oral steroids?

A

Use daily steroid tablet in the lowest dose providing adequate control. Maintain high dose ICS. Consider other Rx to minimise use of steroids.

Refer

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13
Q

Complications of asthma

A

Pneumonia

Pneumothorax

Pneumomediastinum

Resp failure and arrest

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14
Q

What is involved in step 2 regular preventer?

A

200-800micrograms e.g. beclametasone

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15
Q

Give an example of a LTRA

A

Montelukast

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16
Q

Give an example of a LABA

A

Salmetrol

17
Q

Is there a diagnostic test for asthma?

A

No, tests just increase probability

18
Q

How to diagnose asthma?

A

Clinical assessment to determine probability

19
Q

What is involved in a clinical assessment to determine asthma probability?

A

a) history of recurrent episodes of symptoms (ideally corroborated with variable peak flow)
b) symptoms of wheeze, cough, breathlessness, chest tight
c) wheeze recorded by health professional in notes (and variable PEFR or FEV1)
d) personal or FHx atopy
e) no suggestion of alternative diagnosis

20
Q

What is the purpose of spirometry?

A

Demonstrate obstruction

Give baseline to assess response to treatment

Exclude alternative diagnosis

21
Q

Does normal spiro in asymptomatic rule out asthma?

A

No

22
Q

What should you do if the pt has a high probability of asthma?

A

Record this (code as susp asthma) and start treatment (6w ICS)

Assess response objectively with lung function or a validated symptom questionnaire and ideally FEV1/home PEFR

If good response- confirm diagnosis

If poor- check technique and adherence, further tests/alt diagnosis.

23
Q

What should you do if the patient has a medium probability of asthma?

A

Test for airway obstruction (spiro and bronchodilator reversibility)

Investigation options:

  • Test for variability (reversibility, PEFR charts, challenge tests)
  • Test for inflammation/atopy (FeNO- exhaled nitric oxide-, blood eosinophils, skin-prick test, IgE)

If suspected asthma- watchful waiting if asymptomatic, or commence treatment and assess response objectively

Poor response- investigate other diagnosis.

24
Q

What if someone has a low probability of asthma?

A

Investigate/treat for more likely diagnosis

4th Year CCC (19 decks)

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