Asthma

Question 1

What is asthma?

Answer 1

Reversable airway obstruction +/- wheeze, dyspnoea, cough

Question 2

Prevalance higher if …?

Answer 2

LBW
FH
Bottle fed
Atopy
Being male 
Pollution
Past lung disease

Question 3

Triggers?

Answer 3

Pollen 
House dust 
Mites
Feathers 
Fur 
Exercise 
Viruses 
Chemicals 
Smoke 
Traffic

Question 4

Differentials

Answer 4

Foreign body 
Pertussis
Croup 
Pneumonia/TB
Hyperventilation 
Aspiration 
CF - wet cough, starting at birth, failure to thrive

Question 5

What is used to treat exacerbations?

Answer 5

Corticosteroids - prednisolone 30-40mg/day

Question 6

General management

Answer 6

Annual review 
Oral steroid use 
Time off school or nursery 
Check inhaler technique 
Medication adherance 
Advise regarding smoke exposure 
Record height and weight

Question 7

Drug therapy for asthma

Step 1

When is step 2 needed?

Answer 7

Short acting beta agonist via pMDI (Meter-dose inhaler) - salbutamol

Use spacer if needed

If using the inhaler more than 3 times a wk

Question 8

Drug therapy for asthma

Step 2

Answer 8

Inhaled steroids - beclometasone / clenil modulite

Question 9

Drug therapy for asthma

Step 3

What is under 5 yrs?

What is over 5 yrs?

Answer 9

Check inhaler/concordance
Eliminate triggers
Monitor height

Montelukast 4 mg

Inhaled salmeterol (long-acting beta agonist)

Question 10

Drug therapy for asthma

Step 4

Answer 10

Refer to specialist +/- CXR

Increased inhaled steroid (Clenil 400mcp/12hr)

Question 11

Drug therapy for asthma

Step 5

Answer 11

Add prednisolone at lowest dose and see if it works