asthma - precipitating factors & treatment

Question 1

major precipitating factors of asthma attacks?

Answer 1

indoor allergens
outdoor allergens
drugs
chemicals
others

Question 2

indoor allergens?

Answer 2

animals (hair / dander)
house dust mite faeces
mould / fungus

Question 3

outdoor allergens?

Answer 3

pollen
pollutants (car exhaust)
tobacco smoke
perfumes

Question 4

drugs - precipitating factors?

Answer 4

NSADS & ß-blockers

Question 5

chemical precipitating factors?

Answer 5

isocyanates, acid anhydrides (varnish / paint)

Question 6

other precipitating factors?

Answer 6

exercise
cold air
emotional distress

Question 7

principle treatments of asthma?

Answer 7

oxygen

salbutamol nebulisers & atrovent nebulisers

Question 8

how do you administer nebulisers?

Answer 8

one after the other (salbutamol & atrovent) until patient can breath again

Question 9

what happens if airways too narrow for nebulisers?

Answer 9

IV access

Question 10

what if nebulisers don’t work?

Answer 10

may need to intubate & ITU admission

Question 11

what are things patient can do to prevent asthma attacks?

Answer 11

patient education
change pillows & bed-sheets every few years
fresh air
stop smoking

Question 12

how do you decide drug treatment for asthma?

Answer 12

using BTS stepwise approach

Question 13

what are the 2 important classes of drugs used in treatment?

Answer 13

bronchodilators & steroids

Question 14

why are inhalers used?

Answer 14

to deliver drugs in aerosol form

Question 15

what do steroids do?

Answer 15

reduce inflammation
inhibits inflammatory mediators & cells
eosinophils respond well to steroids - prevent release of leukotrienes C4 (toxic to epithelial cells - causes it to shed)

Question 16

what should mild intermittent asthma be treated with?

Answer 16

inhaled short acting ß2-agonist (blue) as required e.g. salbutamol
acute treatment
SAßA

Question 17

when should you decide to take a step up from SAßA?

Answer 17

when the patient uses it more than 3 times a week or has nocturnal symptoms

Question 18

what is the regular preventer therapy? (step up from SAßA)

Answer 18

inhaled steroids (brown inhaler)

Question 19

what is the initial add-on therapy after SAßA?

Answer 19

LAßA (long acting ß2-agonist) - green inhaler

Question 20

what is LAßA not used for?

Answer 20

acute

Question 21

what is patient still has persistent poor control?

Answer 21

increase inhaled steroids

add 4th drug e.g. ß2-agonist tablet

Question 22

what if increasing inhaled steroids still doesn’t work? (step 5)

Answer 22

continuous / frequent use of oral steroids
use daily tablet (lowest dose required for adequate control)
refer patient for specialist care

Question 23

what is always important to assess patients for features of?

Answer 23

acute severe asthma

requires immediate treatment & hospitalisation

Question 24

how do you treat acute severe asthma?

Answer 24

nebulised ß2-agonist and ipratropium (steroids) in delivered oxygen
and IV steroids + short course of high dose oral prednisolone (steroid)

Question 25

what other drugs may be required in acute severe asthma?

Answer 25

magnesium sulphate & aminophylline

Question 26

what do patients with features of life threatening asthma require?

Answer 26

ITU & ventilation

Question 27

how do you diagnose asthma?

Answer 27

full history - ask about symptoms
PMH: eczema, hayfever
FH: atopy, smoking
SH: mould in home, farm, wood burning fire, pets
DH: medications making it worse? NSAIDS, ß-blockers