Asthma Flashcards
What are the typical triggers of asthma?
Infection Night time or early morning exercise animals cold / damp Dust Strong emotions
What are some presenting features suggesting an asthma diagnosis?
Episodic symptoms
diurnal variation
Dry cough with wheeze and shortness of breath
Atopic conditions
Family history
Bilateral widespread polyphonic wheeze heart by a healthcare professional
What are some presenting features indicating a diagnosis other than asthma?
Wheeze related to coughs and colds more suggestive of viral induced wheeze isolated or productive cough normal investigations no response to treatment unilateral wheeze
What are some of the investigations for asthma?
fractional exhaled nitric oxide
Spirometry with bronchodilator reversibility
peak flow variability
direct bronchial challenge test with histamine
What is the first stage of the SIGN stepwise ladder?
Short acting beta 2 against inhaler (salbutamol) as required
What is the second stage of the SIGN stepwise ladder?
Add a regular low dose corticosteroid inhaler (beclomethasone)
What is the third stage of the SIGN stepwise ladder?
Add a LABA inhaler (salmeterol)
What is the fourth stage of the SIGN stepwise ladder?
Consider a trial of an oral leukotriene receptor antagonist (montelukast), oral beta 2 agonist , oral theophylline or inhaled LAMA
What is the fifth stage of the SIGN stepwise ladder?
titrate inhaled corticosteroid up to high dose
combine additional treatments from step 4
refer to specialist
What is the sixth stage of the SIGN stepwise ladder?
add oral steroids at the lowest possible dose to achieve good control
Describe some of the additional management strategies for patients with asthma?
individual asthma self-management programme
yearly flu fab
yearly asthma review
Advise exercise and avoid smoking
