Asthma

Question 1

what are features of life-threatening asthma?

Answer 1

PEFR < 33%

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Question 2

what are features of severe asthma?

Answer 2

PEFR 33-50%
RR > 20
HR > 110

Question 3

describe the manage of an asthma attack.

Answer 3

oxygen via 15l if life-threatening

oral prednisolone 40-50 mg for 5 days orally

ipratropium bromide (if life threatening or not responding to neb)

IV magnesium sulphate

IV aminophylline (specialist advice)

Question 4

what dose of prednisolone would you give a patient who is having an asthma attack?

Answer 4

40-50mg oral prednisolone for 5 days

Question 5

describe the step-wise management of asthma.

Answer 5

SABA 
SABA + ICS
SABA + ICS + LTRA
SABA + ICS + LABA (+/- LTRA) 
SABA +/- LTRA + MART (low dose)
SABA +/- LTRA + MART (medium dose)
SABA +/- LTRA + one of the following 
- high dose ICS fixed dose 
-  add LAMA or theophylline 
- seek advice

Question 6

what FeNO is diagnostic for asthma?

Answer 6

> 40 ppb

Question 7

what variability in PEFR is diagnostic of asthma?

Answer 7

> 20% variability throughout the day

Question 8

what is a low, medium and high dose of ICS?

Answer 8

low = < 400 micrograms
medium - 400- 800 micrograms
high - > 800 microgram

Question 9

when stepping down treatment, what is the first change you should make in treatment?

Answer 9

reduce any steroids by 25-50%