Asthma

Question 1

Name two atopic conditions that a patient may have an addition to asthma?

Answer 1

Allergic dermatitis

Allergic rhinitis

Question 2

What are the symptoms of asthma?

Answer 2

Wheeze

Cough that is worse at night

Breathlessness

Question 3

What are the signs of asthma?

Answer 3

Reduced peak expiratory flow rate

Obstructive signs on spirometry (scalloping) with beta agonist reversibility

Audible wheeze on expiration

Question 4

How are the following affected in asthma?

FVC

FEV1

FEV1:FVC

Answer 4

FVC: normal

FEV1: significantly reduced

FEV1:FVC = <70%

Question 5

What other investigations could be carried out other than spirometry in an asthmatic patient?

Answer 5

Fractional exhaled nitric oxide

CXR: particularly in older patients or those with a history of smoking

Question 6

What is the diagnostic testing for asthmatic patients over the age of 17?

Answer 6

All patients should be asked whether they find their symptoms are worse at work/better when they are at home

All patients should be booked in for spirometry testing

All patients should have a fractionated expiratory NO test.

Question 7

What are the features of acute asthma?

Answer 7

Acute breathlessness, wheeze and cough that is not relieved by salbutamol

May be caused by a chest infection

Question 8

What are the signs of acute moderate asthma

Answer 8

PEFR 50-75% of best or predicted

Question 9

What are the signs of acute severe asthma?

Answer 9

PEFR 33-50%

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RR >25

HR >110

Question 10

What are the signs of life threatening asthma?

Answer 10

PEFR <33% of best or predicted

O2 sats <92% - measure their ABG at this stage

Silent chest

Reduced consciousness

Bradycardia

Hypotension

Question 11

What are the signs of near fatal asthma?

Answer 11

This is when they are in type II respiratory failure.

Question 12

When is a CXR recommended in an asthmatic patient?

Answer 12

When the patient is not responding to treatment

In a patient who has life threatening asthma

In a suspected pneumothorax

Question 13

When should a patient with acute asthma be admitted to hospital?

Answer 13

A patient who has life threatening asthma

A patient who has severe asthma which is not responding to treatment.

Question 14

What is the management of acute asthma?

Answer 14

High flow oxygen (15L via a non rebreather mask) and titrate down to achieve sats of 94-98%

Back to back nebulised salbutamol if the patient has life threatening features. Can be given via a pMDI if the patient is severe or lower.

You should give 40-50mg prednisolone OD and continue to give for 5 days following the acute attack.

If no improvement is observed consider a nebulised ipatropium bromide.

Consider IV aminophylline or IV magnesium sulphate in patients with severe or life threatening features.

In severe/life threatening cases, call ITU for assessment and order a CXR

Question 15

What is the criteria for discharge in a patient with asthma?

Answer 15

Has been stable on their discharge medication (no nebulisers or oxygen) for 12-24 hours

Inhaler technique checked and recorded

Their PEFR >75% best or predicted.

Question 16

Describe the acute asthma discharge care bundle

Answer 16

TAPES

Technique

Action plan

Prescription

Exacerbating factors discussed (Environment)

Secondary care follow up

Question 17

How often should a step down of asthma treatment be attempted?

Answer 17

Once every 3 months.

You can reduce the corticosteroid dose by 25-50% at a time.