asthma (non-acute) management

Question 1

pre-school wheeze is classified by what 2 criteria

Answer 1

flare-up severity

symptom frequency

Question 2

pre-school wheeze - define levels of flare-up severity

Answer 2

mild - managed in community with LABA
moderate - needed steroids or ED
severe - hospitalization or PICU

Question 3

pre-school wheeze - define levels of symptom frequency

Answer 3

symptoms 1 / >6 months
symptoms 1 / >3-4 monthly
symptoms 1 / >4-6 weekly
symptoms >1 day / week

Question 4

pre-school wheeze - which patients should have preventer therapy

Answer 4

anyone who has had moderate or severe flare-up

mild flare-ups > 1 / 4-6 weeks

Question 5

asthma - factors increasing risk of flare-up (3 sx. related, 1 disease related, 2 lifestyle related, 1 rx. related)

Answer 5

• poor asthma control
• having a flare-up 12 months before
• not able to tell how dyspnoeic they are
• other lung disease present
• being poor, drug use, psychosocial problems, mental illness
• smoking and environmental exposure
• using 3 SABA MDIs per year

Question 6

asthma - factors increasing risk of life-threatening flare-up (4 hosp related, 2 rx relate, 2 disease related)

Answer 6

• in ED 3 times for asthma last year
• in hospital twice for asthma in last year
• hospital or ED in last month
• delaying hospital
• being intubated in the past for asthma
• using 12 saba mdis per year increases risk of death
• sudden-onset acute asthma
• CVD

Question 7

asthma in 14+ patients - assessing symptom control (5)

Answer 7

• symptoms affecting daily activities
• frequency of feeling dypsnoeic
• frequency of waking at night with symptoms
• frequency of reliever inhaler use
• subjective feeling of asthma control

Question 8

asthma in 6-11 - indications for preventer therapy (5)

Answer 8

definite

• persistent asthma
• life-threatening flare-up
• moderate severity, frequent intermittent

consider
mild flare-ups + frequent
moderate-severe flare-ups, infrequent

Question 9

asthma in 6-11 - frequency categories (3)

Answer 9

infrequent - 6 weeks or longer per attack
frequent intermittent - attacks every 4-6 weeks
persistent - day symptoms once /week, night symptoms twice a month or symptoms affecting activity or sleep

Question 10

asthma in 6-11 - flare-up severity categories (3)

Answer 10

mild - community managed w/ salbutamol
moderate-severe - >2 episodes needing ED or oral steorids
life-threatening - hospital or PICU

Question 11

asthma in 6-11 - stepped approach to escalating dose

Answer 11

SABA -> flixotide 50 microg 1-2 BD or montelukast 5mg -> add the other | high dose ICS | seretide 100/25 BD | refer

Question 12

montelukast dosage in ages 1-5

Answer 12

4mg

Question 13

montelukast dosage in ages 6-13

Answer 13

5mg

Question 14

montelukast dosages in 14+

Answer 14

10mg

Question 15

risk factors to develop asthma (9)

Answer 15

genetic
- family history of asthma and allergies (esp maternal)

medical history

• past history of atopy and food allergies in early life
• low birth weight
• obesity

tobacco

• in-utero tobacco exposure
• tobacco smoking
• environmental tobacco smoke

environment

• environmental pollution
• work-related exposure