Asthma

Question 1

Name 4 pieces of lifestyle advice to families to avoid their children getting asthma exacerbations

Answer 1

• Removal of feather or woollen bedding
• Wrapping of mattress in plastic
• Cleaning of carpets and furniture
• No pets in the house if the child is allergic to them
• No smoking in house or car
• Parents should stop smoking entirely

Question 2

What are the features of the different types of asthma: mild/moderate/severe/life-threatening

Answer 2

Question 3

An 8-year-old boy presents to the emergency department severely short of breath and wheezy. He is extremely short of breath and cannot complete sentences fully. His peak expiratory flow rate is 300 l/min (40% of normal). His oxygen saturations are 93%. His pCO2 is 4.9 kPa.

Which of the above is most concerning?

A. Wheeziness

B. pCO2 (kPa)

C. Peak Expiratory Flow Rate

D. Oxygen saturations

E. Cannot complete sentences

Answer 3

B. pCO2

Normal pCO2 is 4.8kPa to 6.0kPa. The fact that an child in an acute asthma attack has a normal pCO2, suggests that he is tiring out. Requires immediate senior review. Possibly intubation

Question 4

What are the different steps of management for acute asthma attack?

Answer 4

1st line

Oxygen

Salbutamol (pMD + spacer/nebulised)

Oral corticosteroids

2nd line

Nebulised ipratropium

Consider nebulised nebulised MgSO4

3rd line

IV salbutamol

IV MgSO4

Consider aminophylline

4th line

Call anaesthetist for rapid sequence induction

Question 5

What are the different steps of management for chronic asthma for children 5 - 16 yrs old?

Answer 5

FOR CHILDREN 5 - 16 YRS OLD

Reliever therapy

• SABA i.e salbutamol PRN (Ventolin) [1^st line]

Maintenance therapy

• Low-dose ICS i.e Budesonide 200mcg [2^nd line]
• LRTA i.e Montelukast + ICS [3^rd line]
• LABA i.e Salmeterol + ICS [4^th line]
• MART therapy (combined ICS and LABA) [5^th line]
• Same as above 2 but increase dose of steroid to moderate maintenance [6^th line]
• Increase steroid dose to high maintenance dose** and consider trial of additional drug i.e **theophylline/Refer to specialist [7^th line]

Question 6

What are the different steps of management for chronic asthma for children <5 years old?

Answer 6

Reliever therapy

• SABA i.e salbutamol PRN (Ventolin) [1^st line]

Maintenance therapy

• 8-weel trial of moderate-dose ICS [2^nd line]
• Add LRTA i.e Montelukast + ICS [3^rd line]
• Refer to specialist [4th line]