Bronchial Asthma

Question 1

Pooled weighted prevalence of asthma

Answer 1

14.3%

Question 2

Airway narrowing in asthma bc of ?

Answer 2

1- mucus secretion

2- bronchial wall thickening due to edema, smooth muscle hyper-atrophy and sub-epithelial fibrosis

Question 3

Asthma symptoms worse at?

Answer 3

At night particularly in children mostly coughing

Question 4

What can worsen asthma ?

Answer 4

• beta blockers
• aspirin
• NSAIDs
• GERD

Question 5

Gold standard?

Answer 5

Spirometry to confirm a way of instruction and demonstrate significant reversibility but performing a spirometry.

-The degree of significant reversibility is defined as an improvement in force expiratory volume in the first second fourth expiratory volume -> 12% and _> 200ml from the prebronchodilator value

Question 6

Asthma Dx in children

Answer 6

• don’t use spirometry in children <6 years
• for infant due x-ray to exclude congenital causes
• do hypersensitivity test : skin testing , IgE ,
• hx of cough for >2 weeks at night not related to URTI
• hx of wheezing : must be at both side and with expiration
• hx of multiple attack of SOB or wheezing /season : >3 attack / season

Question 7

Prediction of asthma in preschool children

Answer 7

• history of -> 4 wheezing attack
  With (one or more of major Cr) / or (two or more of minor Cr )

-major criteria:
Family history of asthma, skin-test positive to allergens, eczema (physician diagnosed a topic dermatitis)

-minor criteria:
Allergic sensitization to milk eggs or peanuts, eosinophilia more than 4%, wheezing unrelated to cold

Question 8

Asthma control test score

Answer 8

• controlled : ->20
• partially controlled: 16-19
• uncontrolled : <16

Question 9

Medication for asthma

Answer 9

Relievers/rescue medication

-salbutamol (SABA) used as needed- basis

• formetrol/ICS combination used as needed- basis
  Formetrol ( is a LABA) with fast bronchodilator effect

Question 10

Controller medication

Answer 10

• inhaler corticosteroids ICS is considered most effective controller and the cornerstone of asthma treatment
• if the patient is uncontrolled maybe adding addition controller medication
• leukotrienes receptor antagonist 

Question 11

Tx initiation

Answer 11

-controlled ACT>20
Give formetrol/ICS as needed
And give low dose ICS for special situations

-partially controlled 16-19 
Give “low” dose ICS 
use SABA as a reliever
Formetrol/ICS as needed 
And give LTRA 

• uncontrolled < 16
• low to “medium” does of ICS with LABA
• for acute attack my require “oral” corticosteroids

Question 12

Management need to continue for at least before lowering or cutting medication

Answer 12

3 months

Question 13

Tx adjustment and maintenance

Answer 13

1- mild (step 1,2) 
Step1 
Formetol/ICS as needed 
SABA with ICS as needed 
Step 2 
Low maintenance dose of ICS as needed 
Or formetrol/ICS 
Alternatively: LTRA. 

2-moderate (step3) 
Step3 
- low dose ICS + LABA 
alternative? - low dose ICS +LTRA 
- medium dose ICS 
-low to medium ICS+ theophylline 

3- sever ( step 4,5) 
Step 4:
-medium to high dose ICS+ LABA 
add on therapy : 
LAMA 
LTRA 

Step5-
Immune therapy
Anti IgE

Less preferred ? Oral corticosteroids

Question 14

Mx of children less 5 ?

Answer 14

5 steps( all the steps includes salbutamol as needed )

Step1 : salbutamol as needed
Step 2
- low dose ICS OR leukotrienes modifiers

Step3
- double dose ICS. OR. Low dose ICS + L modifiers

Step4:
-double ICS + L modifiers

Step5 :
Use step4 regimen + systemic steroids

Question 15

When to refer to specialist ?

Answer 15

After step 3

Question 16

Mx for 5 to 12 years old

Answer 16

Step 1
Salbutamol

Step 2
Low ICS OR. L modifiers

Step3 
Low ICS+ LABA.
Or 
Medium to high ICS   
OR. Low ICS+ L modifiers 

Step4 : medium to high ICS + LABA
+/- L modifiers

Step5
Step4 regimen + systemic steroid and consider (biologic therapy )

Question 17

Interval of follow ups ?

Answer 17

1-3 months

Question 18

Acute asthma assessment look in your phone notes

Answer 18

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