Asthma Management - Adults

Question 1

What is the asthma triad?

Answer 1

Airway inflammation
airflow obstruction
Bronchial hyperresponsiveness

Question 2

What are the signs indicating asthma?

Answer 2

Response to treatment

• episodic
• obstructed spirometry
• eczema

Question 3

Complete control of asthma is defined as…

Answer 3

• no daytime symptoms
• no night-time awakening due to asthma
• no need for rescue medication
• no asthma attacks
• no limitations on activity including exercise
• normal lung function
• minimal side effects from medication (e.g. steroids)

Question 4

What is considered normal lung function in terms of FEV1 and PEF?

Answer 4

In practical terms FEV1 and/or PEF>80% predicted or best.

Question 5

What are the non-pharmacological methods of managing asthma?

Answer 5

• Patient Education and Self management plans
• Exercise
• Smoking cessation
• Weight management
• Flu/Pneumococcal vaccinations
• Asthma reviews/action plans

Question 6

What are some common inhalers used in relieving asthma?

Answer 6

MDI - metered dose inhalers

DPI - dry powder inhalers

Question 7

What are some oral therapy drugs that may be used in treating asthma?

Answer 7

• LTRA (e.g. Montelukast)
• Theophylline (bronchodilator)
• Prednisolone (oral steroid)

Question 8

What are the specialist treatments for asthma?

Answer 8

• omalizumab (anti IgE)
• mepolizumab (anti IL-5)
• bronchial thermoplasty

Question 9

What are the SABAs used for asthma?

Answer 9

Salbutamol

Terbutaline

Question 10

What are the features of acute severe asthma?

Answer 10

Any one of:

• PEF 33-50% best or predicted
• respiratory rate >/= 25bpm
• heart rate >/= 110bpm
• inability to complete sentence in one breath

Question 11

What are the features of life threatening asthma?

Answer 11

• altered conscious level
• exhaustion
• Arrhythmis
• hypotension
• cyanosis
• silent chest

PEF <33% best or predicted
SpO2<92%
PaO2<8kPa
normal PaCO2 (might indicate hypoventilation)

Question 12

What are the features of a near-fatal asthma attack?

Answer 12

raised PaCO2 and/or mechanical ventilation required

Question 13

What is the management of a mild/moderate asthma attack out of hospital?

5 points

Answer 13

• Increase inhaler use
• Oral Steroid
• Treat trigger
• Early follow up
• Back up plan

Question 14

What is the management of a moderate/severe asthma attack in hospital?

8 points

Answer 14

• Nebulisers – Salbutamol/Ipratropium
• Oral/IV Steroid
• IV Magnesium
• Aminophylline
• Triggers – infection/allergen
• Complications – CXR
• Review
• Level 2/3 care

Question 15

What is the treatment if asthma is suspected?

Answer 15

Monitored treatment of ICS, SABA when required

Question 16

What is step 1 of asthma treatment?

Answer 16

low dose ICS (e.g. beclometasone)

Question 17

What is step 2 of asthma treatment?

Answer 17

higher dose ICS + adding in inhaled LABA

Question 18

What is step 3 of asthma treatment?

Answer 18

Stop LABA (if no response to it) and increase dose of ICS

or

Continue LABA (if beneficial) and increase ICS dose

or

Continue both and add LTRA, theophylline or LAMA.

Question 19

What is step 4 of asthma treatment?

Answer 19

Trials of:

Increasing ICS up to higher dose
addition of a 4th drug eg. LTRA, slow release theophylline, beta agonist tablet, LAMA

Question 20

What is step 5 of asthma treatment?

Answer 20

Use daily steroid tablet (e.g. prednisolone) in the lowest dose providing adequate control

or

Maintain high dose ICS

or

Consider other treatments to minimise use of steroid tablets

+ refer to specialist

Question 21

What are contrasts between asthma and COPD?

Answer 21

Age of onset
Smoking history
Response to treatment
Treatment goals
Trajectory