Asthma

Question 1

0-4yo using salbutamol, Montelukast and low dose fluticasone. What’s the next step?

Answer 1

Specialist referral

Question 2

5-11yo on salbutamol and and formoterol with budesonide, next step in asthma?

Answer 2

• Continue SABA
• Increase ICS (budesonide) to low dose
• Continue LABA (formoterol) if response, or stop if no response
• Add LTRA e.g. Montelukast 5mg po od

Question 3

0-4yo using salbutamol, Montelukast and v low dose fluticasone. What’s the next step?

Answer 3

Continue LTRA and SABA

Increase fluticasone (ICS) to low dose

Question 4

0-4yo using salbutamol, what’s the next step?

Answer 4

Continue SABA

Add either:
- v low-dose ICS e.g. fluticasone 50ug bd / budesonide 125ug bd
or
- LTRA e.g. Montelukast 4mg po od

Question 5

5-11yo on salbutamol, formoterol, low dose budesonide and Montelukast, next step in asthma?

Answer 5

Refer to specialist

Question 6

5-11yo on salbutamol, fluticasone and Montelukast, next step in asthma?

Answer 6

Continue SABA and LTRA

Increase ICS to low dose

Add LABA e.g. fluticasone with formoterol/salmeterol inhaler 2 puffs bd

Question 7

5-11yo on salbutamol and and fluticasone with salmeterol, next step in asthma?

Answer 7

• Continue SABA
• Increase ICS (fluticasone) to low dose
• Continue LABA (salmeterol) if response, or stop if no response
• Add LTRA e.g. Montelukast 5mg po od

Question 8

5-11yo on salbutamol and budesonide, next step in asthma?

Answer 8

Continue SABA and v low dose ICS

Add either:
- LABA e.g. formoterol with budesonide inhaler 1-2 puffs bd
or
- LTRA e.g. Montelukast 5mg po od

Question 9

5-11yo on salbutamol and fluticasone, next step in asthma?

Answer 9

Continue SABA and v low dose ICS

Add either:
- LABA e.g. fluticasone with formoterol/salmeterol inhaler 2 puffs bd
or
- LTRA e.g. Montelukast 5mg po od

Question 10

5-11yo on salbutamol, next step in asthma?

Answer 10

Continue SABA

Add v low-dose ICS inhaler e.g.
Fluticasone 50ug bd,
Budesonide 125ug bd
Beclomethasone 100ug bd

Question 11

5-11yo on salbutamol, salmeterol, low dose fluticasone and Montelukast, next step in asthma?

Answer 11

Refer to specialist

Question 12

5-11yo on salbutamol, budesonide and Montelukast, next step in asthma?

Answer 12

Continue SABA and LTRA

Increase ICS to low dose

Add LABA e.g. formoterol with budesonide inhaler 1-2 puffs bd

Question 13

When do you move up a step in paediatric asthma?

Answer 13

If using SABA >3 doses/week

Question 14

Trial tx for paeds asthma?

Answer 14

SABA prn e.g. salbutamol 1-2 puffs 5 mins before exercise or every 4-6 hrs as required

Very low dose ICS inhaler e.g. fluticasone / budesonide

Question 15

0-4yo using salbutamol, Montelukast and v low dose budesonide. What’s the next step?

Answer 15

Continue LTRA and SABA

Increase budesonide (ICS) to low dose

Question 16

0-4yo using salbutamol, Montelukast and low dose budesonide. What’s the next step?

Answer 16

Specialist referral

Question 17

What can be given for oral candidiasis?

Answer 17

Miconazole gel or nystatin oral/topical

Question 18

Step 1 of 5-11yo asthma

Answer 18

SABA prn e.g. salbutamol 2 puffs (200ug) 5 mins before exercise or every 4-6 hrs as required

Question 19

0-4yo using salbutamol and Montelukast, what’s the next step?

Answer 19

Continue SABA and LTRA

Add v low-dose ICS e.g. fluticasone 50ug bd / budesonide 125ug bd

Question 20

0-4yo using salbutamol and budesonide, what’s the next step?

Answer 20

Continue SABA and v low dose ICS

Add LTRA e.g. Montelukast 4mg po od

Question 21

Step 1 of asthma age 0-4yo

Answer 21

SABA prn e.g. salbutamol 1-2 puffs (100-200ug) 5 mins before exercise or every 4-6 hrs as required

Question 22

0-4yo using salbutamol and fluticasone, what’s the next step?

Answer 22

Continue SABA and v low dose ICS

Add LTRA e.g. Montelukast 4mg po od

Question 23

5-11yo on salbutamol and and fluticasone with formoterol, next step in asthma?

Answer 23

• Continue SABA
• Increase ICS (fluticasone) to low dose
• Continue LABA (formoterol) if response, or stop if no response
• Add LTRA e.g. Montelukast 5mg po od

Question 24

What drugs are given for acute exacerbation of asthma?

Answer 24

Nebulisers:

• High flow O2
• Salbutamol
• Possibly add ipratropium bromide if not responding

Steroids:

• IV hydrocortisone 100mg if severe
• PO prednisolone 50mg if less severe