ASTHMA GUIDELINES

Question 1

adult asthma BTS guidelines

Answer 1

1) low dose ICS
2) +LABA to ICS
3) increase ICS dose / +LTRA

(if no response to LABA - STOP)

4) specialist

Question 2

child asthma BTS guidelines

Answer 2

1) very low dose ICS

OR LTRA <5yrs

2) >5 = +LABA/LTRA

<5 = +LTRA

3) increase ICS to low rose

or +LABA/LTRA

(if no response to LABA - STOP)

4) specialist

Question 3

moderate acute asthma

Answer 3

PIN

• PEF >50–75% best or predicted
• increasing symptoms
• no features of acute severe asthma

Question 4

severe acute asthma

Answer 4

PRSH

• PEF 33–50% best or predicted
• RR ≥25/min

• inability to complete
sentences in one breath

• HR ≥110/min

Question 5

life threatening asthma

Answer 5

In a patient with severe asthma any one of:

• PEF <33% best or predicted
• SpO₂ <92%
• PaO₂ <8 kPa
• ‘normal’ PaCO₂ (4.6–6.0 kPa)
• altered conscious level
• exhaustion
• arrhythmia
• hypotension
• cyanosis
• silent chest
• poor respiratory effort

Question 6

management of acute asthma in adults

Answer 6

oxygen

steroid therapy

high dose B2Agonists

Ipratropium 0.5mg 4-6 hourly

Other:

MgSO4 1.2-2g IV over 20mins in patients with acute severe

Question 7

oxygen aim when treating acute asthma

Answer 7

94-98%

Question 8

prednisolone dose in acute asthma

Answer 8

40-50mg daily for 5 days

Question 9

acute severe asthma in children

Answer 9

SpO₂ <92%

PEF 33–50% best or predicted

Can’t complete sentences in one breath

Heart rate
>140/min (1-5 years)
or
>125/min (>5 years)

Respiratory rate
>40/min (1-5 years)
or
>30/min (>5 years)

Question 10

life threatening asthma in children

Answer 10

SpO₂ <92%

PEF <33% best or predicted

Exhaustion
Hypotension
Cyanosis
Silent chest
Poor respiratory effort
Confusion

Question 11

treating acute asthma in children over 1

Answer 11

B2Ag - discontinue any LABA

+ipratropium 250mcg

+150mg MgSO4 in first hour in children with spO2 <92%

Question 12

steroid therapy in child < 2

Answer 12

10mg 3 days

Question 13

steroid therapy in child 2-5

Answer 13

20mg 3 days

Question 14

steroid therapy in child >5

Answer 14

30-40mg 3 days

Question 15

asthma NICE guidelines >17yo

Answer 15

1) SABA
2) +low dose ICS
3) +LTRA and review in 4-8 weeks
4) +LABA and assess need for LTRA
5) consider MART
6) Increase ICS to high maintenance dose / trial LAMA/theophylline / specialist

Question 16

when to add ICS

Answer 16

using SABA >3 x a week

waking at night

Question 17

asthma NICE guidelines age 5-16

Answer 17

1) SABA
2) +low dose ICS
3) +LTRA and review in 4-8 weeks
4) +LABA and assess need for LTRA
5) consider MART
6) Increase ICS to high maintenance dose / trial LAMA/theophylline / specialist

Question 18

asthma NICE guidelines age <5

Answer 18

1) SABA
2) 8 week trial of ICS

if symptoms didn’t resolve, alternative diagnosis?

reoccurred within 4 weeks of stopping - restart as low dose

reoccurred beyond 4 weeks after stopping - repeat trial

3) +LTRA
4) stop LTRA and refer