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BNF Chapter 3 - Respiratory > Asthma > Flashcards

Asthma Flashcards

1
Q

What ratio of FEV1 to FVC would indicate a possible asthma diagnosis?

A

Less than 70.

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2
Q

Why is exhaled nitric oxide used to aid a diagnosis of asthma?

A

Excess nitric oxide is exhaled due to increased bronchial inflammation.

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3
Q

What dose of oral prednisolone is given to treat exacerbations of asthma?

A

30-40mg.

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4
Q

Which oral steroid is commonly used to treat an acute exacerbation of asthma?

A

Prednisolone.

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5
Q

Define MART therapy?

A

Maintenance and reliever therapy.

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6
Q

Give an example of a MART inhaler?

A

Fostair 100/6 and 200/6.

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7
Q

What are some benefits of MART therapy?

A

Adherence, ease of use, convenience.

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8
Q

What are some disadvantages of MART therapy?

A

Overdose of steroid, difficulty managing doses.

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9
Q

What is the regular preventer therapy considered for use in adults with asthma?

A

Low dose ICS, initially BD. OD can be considered.

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10
Q

What is the initial add on therapy considered for adults with asthma?

A

LABA. Combination of ICS and LABA possible.

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11
Q

What additional controller therapies are considered for adults with asthma?

A

Increased dose of ICS or add LTRS (e.g. montelukast).

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12
Q

When are specialist therapies considered for adults and children with asthma?

A

When adequate asthma control is not achieved by recommended therapies?

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13
Q

What is the regular preventer therapy considered for use in children with asthma?

A

Very low dose ICS of LTRA (e.g. montelukast) if <5 years.

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14
Q

What is the initial add on therapy considered for children with asthma?

A

Very low dose ICS. Add LABA or LTRA (e.g. montelukast) if child >5 years. Add LTRA if child <5 years. Refer children <5 for specialist care if no response.

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15
Q

What additional controller therapies ate considered for children with asthma?

A

Increased dose of ICS or ass LTRA or LABA (children >5 years). Stop LABA if no response.

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16
Q

Which tests are used to diagnose asthma in adults?

A

Fractional exhaled nitric acid. Obstructive spirometry. Bronchodilator reversibility test. Peak flow test. Direct bronchial challenge test.

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17
Q

Describe a bronchodilator reversibility test.

A

Spirometry is performed. After 15 minutes, the patient is then given a bronchodilator (e.g. salbutamol) and retested. A change in the results indicated asthma.

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18
Q

Which tests are used to diagnose asthma in young people and children?

A

Fractional exhaled nitric acid. Obstructive spirometry. Bronchodilator reversibility test. Peak flow test.

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19
Q

Which tools are used to assess asthma and asthma control?

A

Questionnaires.

20
Q

Which risk factors can exacerbate asthma?

A

Weather (cold). URTIs. Food. Pollution. Smoking. Alcohol. Emotions. Hormonal changes. Stress/anxiety. Lack of adherence. Exercise. Beta-blockers. NSAIDs.

21
Q

What are the aims of asthma management?

A

No daytime symptoms. No night waking due to symptoms. No need to use reliever. No need for emergency treatment. Reduce long term lung damage. No limit on daily life. Improved QOL. Optimise medication whilst reducing side effects.

22
Q

What non-pharmacological advice can be given to help a patient manage asthma?

A

Avoidance of triggers. Educational material. Dietary advice. Exercise advice. Smoking cessation. Avoidance of triggering medicines.

23
Q

What is contained in a personalised asthma action plan (PAAP)?

A

Medications and when and how to take them. Symptoms to look out for. How to handle symptoms. Emergency action to take during an attack. How to manage side effects of medicines.

24
Q

Define complete control of asthma.

A

No daytime symptoms, no night time awakening due to asthma, no asthma attacks, no need for rescue meds, no limitations on activity including exercise, normal lung function.

25
Q

Severe attacks of asthma can have an adverse effect on pregnancy, how should they be treated?

A

In hospital with conventional therapy and closely monitored.

26
Q

What lifestyle advice can be given to patients with chronic asthma?

A

Weight loss in overweight patients, smoking cessation, breathing exercises.

27
Q

What does exercise induced asthma usually indicate?

A

Poorly controlled asthma, treatment may need stepping up.

28
Q

Once asthma control is achieved and to avoid unwanted side effects, how should treatment be stepped down?

A

Stepped down by 25-50% every three months. Patients should be maintained on the lowest possible dose of inhaled corticosteroid.

29
Q

What treatment is recommended for children under 5 years with mild intermittent asthma?

A

Inhaled SABA such as salbutamol or terbutaline.

30
Q

If regular preventer therapy is required for children under 5 years with asthma, what is recommended?

A

Add ICS or LTRA if ICS unacceptable.

31
Q

What initial add on therapy is recommended in children under 5 years with asthma?

A

If aged between 2-5 years, add LTRA or ICS.

If aged under 2 years, seek specialist medical advice.

32
Q

If a child under 5 with asthma has persistent poor control over symptoms after other treatments attempted, what is the next step?

A

Refer for specialist medical advice.

33
Q

When treating children under 5 with asthma with steroids, when should a steroid treatment card be issued?

A

High doses associated with systemic side-effects, growth failure, reduced bone mineral density, adrenal suppression.

34
Q

When a child under 5 with asthma is treated with steroids, what should be monitored?

A

Eyes for cataracts and weight and height for growth.

35
Q

What treatment is recommended for adults and children over 5 years with asthma?

A

Inhaled SABA such as salbutamol or terbutaline.

36
Q

What regular preventer therapy is recommended for adults and children over 5 with asthma?

A

Inhaled ICS or LTRA/theophylline if ICS not accepted.

37
Q

What is the initial add on therapy recommended for adults and children over 5 with asthma?

A

Regular LABA (formoterol or salmeterol) - if no response discontinue and increase dose of ICS. Consider trial of LTRA or MR theophylline.

38
Q

What treatment is recommended when an adult or a child over 5 with asthma has persistent poor control?

A

Increase ICS to max dose. Consider adding fourth therapy - LTRA, MR theophylline, MR beta-2 agonist.

39
Q

If an adult or a child over 5 years with asthma is continuously using oral corticosteroids, what treatment is recommended?

A

Refer to specialist care. Initiation on regular oral corticosteroids.

40
Q

Describe the management of acute asthma.

A

High flow oxygen (40-60%) to maintain O2 sats between 94-98%. Beta-2 agonist administered via oxygen-driven nebs. Oral prednisolone OD for at least 5 days or until recovery.

41
Q

What agents can be added to the management of acute asthma, should regular treatment not be sufficient?

A

Nebulised tiotropium bromide. IV MgSO4. IV aminophylline (caution of patient already on theophylline).

42
Q

Describe moderate acute asthma.

A

Increasing symptoms. Peak flow > 50-75% best or predicted. No features of acute severe asthma.

43
Q

Describe severe acute asthma.

A

Any one of the following:

  • Peak flow 33-50% best or predicted.
  • RR > 25/min.
  • HR > 110/min.
  • Inability to complete sentences in one breath.
44
Q

Describe life-threatening acute asthma.

A

Any of the following in a patient with severe acute asthma:

  • Peak flow < 33% best or predicted.
  • O2 sats < 92%.
  • Patial arterial O2 pressure < 8 kPa.
  • Normal partial arterial pressure of CO2.
  • Silent chest.
  • Cyanosis.
  • Poor respiratory effort.
  • Arrhythmia.
  • Exhaustion.
  • Altered consciousness.
  • Hypotension.
45
Q

Describe the key feature of near fatal acute asthma.

A

Raised partial arterial pressure of CO2, requiring mechanical ventilation with raised inflation pressures, or both.

BNF Chapter 3 - Respiratory (8 decks)

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