Chapter 3: Respiratory system Flashcards
1
Q
DPIs are recommended in children over what age?
A
5 years
In 3 and 5 years DPI can be considered if existing treatment is ineffective
2
Q
What is the MHRA advice surrounding PMDIs?
A
Risk of airway obstruction from aspiration of loose objects. REMIND PATIENTS:
- Remove mouthpiece cover fully, shake the device and check both outside and inside of mouthpiece are clear and undamaged before inhaling a dose.
- Store with mouthpiece cover on.
3
Q
What are the different types of inhalers?
A
DPI
MDI
Breath actuated
4
Q
How should you clean spacer devices?
A
Clean once a month by washing in mild detergent and then allowed to dry in air without rinsing; the mouthpiece should be wiped clean of detergent before use.
5
Q
How often should spacers be replaced?
A
Every 6-12 months
6
Q
What are the main nebulised drugs and their associated indications?
A
- b2 agonist / ipratropium bromide = acute exacerbation of asthma/COPD
- b2 agonist, corticosteroid, or ipratropium bromide on a reg basis = severe asthma or reversible airways obstruction when unable to use other inhalational devices
- An antibiotic (eg colistimethate sodium) or a mucolytic = cystic fibrosis
- Budesonide/adrenaline to child with severe croup
- Pentamidine isetionate for the prophylaxis and treatment of pneumocystis pneumonia.
7
Q
Why would you want to avoid high dose ICS in children?
A
Associated with adrenal suppression, growth impairment and reduced bone mineral density.
8
Q
According to BTS guidelines, what should be prescribed if a patient has been diagnosed with asthma?
How does this differ in children?
A
Adult: SABA + Consider monitored initiation with low dose ICS
Children: Still use SABA but can start with a VERY low dose of ICS
If the pt is still symptomatic, short-lived wheezes, ICS should be used as a regular preventer
9
Q
According to BTS and NICE guidelines, in what situations would a patient need a regular preventor?
A
- If they are using 3 or more doses of their SABA a week
- Symptomatic 3 times a week or more
- Waking at night symptoms at least weekly
- Had asthma attack in the last 2 years
10
Q
BTS asthma guidelines in adults:
If a patient is on a regular low dose ICS and SABA yet symptoms are not being controlled, what would the next step up be?
A
Initial add on therapy;
Add inhaled LABA (normally as a combination inhaler with ICS) fixed dose or MART (Maintenance + Reliever therapy)
Currently: SABA + low dose ICS + LABA
11
Q
BTS asthma Adults - Pt meds:
Low dose ICS and LABA combo
SABA
If no response to the LABA, what would the next step be?
A
Additional controller therapy;
Consider Stopping LABA and increase dose of ICS or adding LTRA
ltra; montelukast / zafirlukast
12
Q
BTS asthma Adults - Pt meds:
Low dose ICS and LABA combo
SABA
If the patient is benefitting from the LABA yet symptoms are still not being controlled, what would the next step be?
A
Additional controller therapy;
Continue LABA and increase ICS to medium dose
At this point can also consider trials of:
LTRA //
S-R Theophylline
LAMA
13
Q
BTS asthma Adults - Patient’s regular meds:
Medium dose ICS and LABA combination
SABA & Has had a trial of LTRA
If a patient is still symptomatic, what would the next step be?
A
Refer to specialist care.
14
Q
BTS asthma guidelines in adults:
If exercise is a specific problem in patients taking inhaled corticosteroids who are otherwise well controlled, consider adding one of the following therapies:
A
- leukotriene receptor antagonists
- long-acting β₂ agonists
- sodium cromoglicate or nedocromil sodium
- theophyllines.
Immediately prior to exercise, inhaled short-acting β₂ agonists are the drug of choice.
15
Q
In an asthma attack, if a patient required nebulisers, is this driven by air or oxygen?
A
Oxygen
16
Q
For asthmatic children under 5 years, what type of inhaler is recommended for bronchodilator therapy?
A
pMDI and spacer device, with facemask if necessary.
It contains a pressurised inactive gas that propels a dose in each ‘puff’ by pressing the top. Quick to use, small, and convenient to carry. It needs good co-ordination to press the canister and breathe in fully at the same time. Also known as “evohalers”
17
Q
For asthmatic children under 5 years, what type of inhaler is recommended for corticosteroid therapy?
A
Pressurised metered-dose inhaler and spacer device, with a facemask if necessary
18
Q
For asthmatic children between 5 and 15, what type of inhaler is recommended for corticosteroid therapy?
A
Pressurised metered-dose inhaler and spacer device
19
Q
For asthmatic children between 5 and 15, what type(s) of inhalers is recommended for bronchodilator therapy?
Difference between pMDI, breath actuated MDI, DPI?
A
Consider a wider range of inhalers- not just PMDIs. What suits the patient and compliance
Pmdi; The standard MDI is the most widely used inhaler. However, common errors:
- Not shaking inhaler before using it.
- Inhaling too sharply /wrong time.
- Not holding your breath long enough after breathing in the contents.
BAI do not require you to press canister while you breathe in.
Other breath-activated inhalers are also calledDPI. These inhalers do not contain the pressurised inactive gas to propel the medicine. You don’t have to push the canister to release a dose. Instead, you trigger a dose by breathing in at the mouthpiece. Accuhalers, clickhalers, easyhalers, novolizers, turbohalers and twisthalers are all breath-activated dry powder inhalers. You need to breathe in fairly hard to get the powder into your lungs.
20
Q
What is the target peak expiratory flow in asthma?
A
> 80%
21
Q
- BTS asthma guidelines recommend that ICS should be initially taken how many times a day?
2 .What steroid is the exception to this?
A
- Twice a day
(However, the same total daily dose, taken once a day, can be considered in patients with milder disease if good or complete control of asthma is established) - Ciclesonide should be taken only once daily initially (only twice daily in severe asthma)
22
Q
True or false:
BTS recommend that inhalers do not need to be prescribed by brand
A
False
They should be prescribed by brand
23
Q
How long should be the initial trial of an ICS be in a child under 5?
After this trial, in what situation would you continue the ICS?
A
8 weeks and then review to see if it has benefitted
If they had another exacerbation within 4 weeks of stopping, then continue
24
Q
When would you consider decreasing maintenance therapy for asthma?
What is the recommended dose reduction for ICS at a time and how often?
A
When a patient’s asthma has been controlled with their current maintenance therapy for at least THREE months
Reduction of 25-50% ICS dose every 3 months
25
Can inhaled corticosteroids be used during pregnancy for asthma?
Yes
26
Can oral corticosteroids be used during pregnancy for asthma?
Yes
27
Acute severe asthma qualifying signs/symptoms?
What is 1st line for acute asthma in adults?
Acute severe asthma qualifies for any of:
• PEF 33–50% best or predicted
• respiratory rate ≥25/min
• heart rate ≥110/min
• inability to complete sentences in one breath
■ Supplementary oxygen to all hypoxaemic pts. Maintain SpO2 level 94–98%. Do not delay if pulse oximetry is unavailable.
■ 1st line: high-dose inhaled SABA (salbutamol /terbutaline) ASAP. If response is poor, consider continuous nebulisation. IV b2 agonists are reserved for whom inhaled therapy cannot be used reliably.
■ In all cases of acute asthma, prescribe adequate dose of oral prednisolone. Continue ICS during oral corticosteroid treatment. Parenteral hydrocortisone or IM methylprednisolone are alternatives if unable to take oral prednisolone.
28
In what situation would you use IV beta 2 agonists for acute asthma in adults?
IV beta2 agonists are reserved for those patients in whom inhaled therapy cannot be used reliably.
29
In severe acute adult asthma, if the patient has poor response to nebulised SABA, what can be added?
Nebulised ipratropium
30
What kind of drug is ipratropium?
SAMA
31
What kind of drug is tiotropium?
LAMA
32
Are brands of ICS interchangeable?
No- all contain different doses of different steroids
33
Is LABA monotherapy recommended in asthma?
No
Should always have an ICS or combination inhaler with ICS
Associated with ADRs and death
34
What type of inhaler is an accuhaler?
DPI
35
What type of inhaler is an evohaler?
MDI
36
What is a disadvantage of a DPI?
Breath actuated, need to have respiratory effort for it
| If not, MDI is more appropriate
37
What is the only LAMA licensed for asthma?
Tiotropium
38
Which tiotropium inhaler is licensed in asthma?
Spiriva Respimat 2.5 mcg (2p OD)
The following are only licensed in COPD:
- Braltus 10 mcg capsules (Zonda)
- Spiriva 18 mcg capsules (Handihaler)
39
What is the only Seretide licensed in COPD?
Seretide 500 Accuhaler
Fluticasone/salmeterol
The lower dose Seretide accuhalers and the evohalers are not licensed
(But all Seretides are licensed for asthma)
40
In children of all ages, what do you give for acute asthma?
Inhaled SABA
| Once daily dose of oral pred, usually for 3 days or until recovery
41
In children of all ages in acute asthma, if an inhaled SABA is not sufficient, what else can be given?
Nebulised ipratropium combined with SABA
42
BTS guidelines:
| In paediatric asthmatic patients, if they are on a SABA and a very low dose ICS, what would the next step be?
1. SABA alone
2. Monitored initiation of very low to low dose ICS
3. Regular preventer: SABA + very low dose ICS
● or <5yrs LTRA
4. Initial Add on therapy; SABA +
● increase to low dose ICS or
● 5 years and above: Add inhaled LABA or LTRA
If no response to LABA consider Stopping LABA
43
BTS guidelines for paediatric asthma
If a patient is on:
SABA
Very low dose ICS
LABA
However there is no response to the LABA, what would the next step be?
1. SABA alone
2. Monitored initiation of very low to low dose ICS
3. Regular preventer: SABA + very low dose ICS
● or <5yrs LTRA
4. Initial Add on therapy; SABA +
● increase to low dose ICS or
● 5 years and above: Add inhaled LABA or LTRA
If no response to LABA consider Stopping LABA, increase to low dose ICS
5. Additional controller therapies
● increase ICS to low dose or
● 5 yrs or above Add LTRA/LABA
44
BTS guidelines for paediatric asthma
If a patient is on:
SABA
Very low dose ICS
LABA/LTRA
If there is benefit from the LABA but control still inadequate, what would the next step be?
1. SABA alone
2. Monitored initiation of very low to low dose ICS
3. Regular preventer: SABA + very low dose ICS
● or <5yrs LTRA
4. Initial Add on therapy; SABA +
● increase to low dose ICS or
● 5 years and above: Add inhaled LABA or LTRA
If no response to LABA consider Stopping LABA
5. Additional controller therapies
● increase ICS to low dose or
● 5 yrs or above Add LTRA/LABA
6. Specialist referral
45
```
BTS guidelines for paediatric asthma - If a patient is on:
SABA
Low dose ICS
LABA
LTRA
```
What would the next step be?
Refer for specialist care
46
How would you treat mild croup?
Mostly self-limiting
Single dose of corticosteroid e.g. dexamethasone may be helpful
47
How would you manage severe croup?
Hospital admission
Steroid- dexa or pred b4 admission
Hospital- give oral/IV dexa or nebulised budesonide
- If this does not provide control- nebulised adrenaline
48
If someone needed oxygen therapy, in what group of patients would you give low concentration rather than high?
COPD
CF
Overdose of opioid and benzos
Lung scarring by TB
49
Theophylline is given as an injection as what drug and why?
Aminophylline, a mixture of theophylline with ethylenediamine, which is 20 times more soluble than theophylline alone
50
Beta agonists can cause deficiency in what electrolyte?
In what group of patients would this be a particular caution?
Can cause hypokalaemia if high doses used
Severe asthma- may be potentiated by concomitant treatment with theophylline, corticosteroids
51
What are the common side effects of beta agonists?
```
Arrythmias
Dizziness
Headache
Hypokalaemia (high doses)
Tremor
Palpitations
Hyperglycaemia - needs monitoring in diabetics
```
52
What is the important safety info on the use of formoterol and salmeterol in asthma?
- added only if standard-dose ICS failed;
- no initiation in rapidly deteriorating asthma;
- intro at low dose and properly monitor before dose increase;
- be discontinued in the absence of benefit;
not be used for the relief of exercise-induced asthma symptoms unless regular ICS are also used;
- be reviewed as clinically appropriate: stepping down therapy should be considered when good long-term asthma control has been achieved.
53
What combination is in a Fostair inhaler?
Beclometasone and formoterol
54
What is a caution in nebulised ipratropium? (what can it cause)?
How can the risk of this be reduced?
Acute angle closed glaucoma, esp in combo with nebulised salbutamol.
Need to protect eyes from neb. drug or powder. If nebulised iptratropium is needed, they need a very tight fitting nebs mask
ALSO cautioned in enlarged prostate and bladder outflow obstruction
55
What is the MHRA advise regarding Braltus tiotropium inhalation capsules?
Reports of patients who have inhaled a Braltus capsule from the mouthpiece into the back of the throat, resulting in coughing and risking aspiration or airway obstruction
56
What combination is in a Relvar Ellipta (92/22)?
ICS LAMA
| Fluticasone and vilanterol
57
What combination is in a Seretide?
ICS LAMA
Fluticasone and salmeterol
Seretide S- salmeterol TID - TIC - FLUTICASONE
58
What combination is in a Symbicort Turbohaler?
ICS LAMA
Budesonide and formoterol
Sym - y ' f ' formoterol
Bi - budesonide
59
What combination is in a Flutiform MDI?
ICS LAMA
| Fluticasone and formoterol
60
What are the LABAs licensed in asthma?
Salmeterol
Formoterol
Indacaterol
Vilanterol
61
```
If a patient is on the following:
SABA
SAMA
ICS
LABA
```
And they are prescribed a LAMA, what medicine should be stopped?
Their SAMA
62
What LAMAs are licensed in asthma?
Tiotropium Spiriva Respimat 2.5 micrograms (dose 2 puffs -5 micrograms)
63
What SABAs are licensed in asthma?
Salbutamol
| Terbutaline
64
What ICS inhalers are licensed in asthma?
Clenil (beclomethasone)
Pulmicort (budesonide)
Flixotide (fluticasone)
65
What steroid is in Clenil?
Beclomethasone
66
What steroid is in Pulmicort?
Budesonide
67
What steroid is in Flixotide?
Fluticasone
68
What ICS/LABA is licensed in asthma?
Relvar Ellipta - fluticasone + vilanterol
Seretide and Sirdupla - fluticasone + salmeterol
Symbicort and Duoresp - budesonide + formoterol
Flutiform - fluticasone + formoterol
Fostair - beclometasone + formoterol
69
What LABAs are licensed in COPD?
Indacaterol
Salmeterol
Formoterol
70
What LAMAs are licensed in COPD?
Glycopyyronium
Aclidinium
Umeclidinium
Tiotropium
71
What combination is Ultibro Breezhaler?
LAMA LABA
Glycopyrronium/indacaterol
72
What combination is Anoro Ellipta?
LAMA LABA
Umeclidium/vilanterol
73
What combination is Duaklir Genuair?
LAMA LABA
Aclidinium/formoterol
74
What combination is Spiolto Respimat?
Tiotropium/Olodaterol
75
True or false:
ICS monotherapy is recommended in COPD patients
False - always prescribe in combination with LABA
Can cause pneumonia, ^ ADRs and increased mortality
76
What is the difference between how to take MDI vs DPI?
MDI - slow and steady
DPI - fast and deep
77
What are the side effects of inhaled antimuscarinics (SAMA and LAMA)?
Dry mouth, headaches, nausea, arrythmias, nose bleeds
78
What is a contraindication to beta agonists?
Hint- pregnancy
Severe pre-eclampsia
79
What LABAs are licensed in COPD?
Formoterol
Salmeterol
Indacaterol
Olodaterol
80
What is the MHRA advice surrounding corticosteroids?
Rare risk of central chorioretinopathy with local and systemic administration
Patients should report any blurred vision/disturbances
81
What are the common side effects of ICS?
- Oral thrush
- Altered voice
- Cushing's syndrome
- Epistaxis / nosebleed
- Throat irritation
- Bronchospasm
82
What monitoring requirement is needed in children on regular ICS?
Annual height and weight
83
What is the important safety information surrounding beclometasone inhalers Qvar and Clenil?
They are not interchangeable as Qvar is TWICE MORE potent due to extra fine particles
Needs to be prescribed by brand
84
Which asthma medicines can be used as normal during pregnancy ?
SABA, LABAs, oral and ICS, sodium cromoglicate and nedocromil sodium, and oral and IV theophylline (with appropriate monitoring) can be used as normal during pregnancy.
85
1. When switching a patient with well controlled asthma from a 200 mcg Clenil to a Qvar, what starting dose should you start with?
2. How does this differ if the patient has poor control asthma and the patient is on 100 mcg Clenil?
1. Start with 100 mcg Qvar
| 2. Same dose as Clenil- 100 mcg
86
Are Clenil and Qvar inhalers licensed in COPD?
No- but beclometasone is licensed if in combination with formoterol (+/- glycopyrronium)
Beclo and formoterol - Fostair
Becloand formoterol and glycopyrronium - Trimbow
87
What is the Fostair 100/6 (including nexthaler) licensed for?
COPD and asthma
Beclometasone and formoterol
88
What is the Fostair 200/6 (including nexthaler) licensed for?
Asthma only
Not COPD.
Beclometasone and formoterol
89
True or false:
| Only the higher strength Fostair (200/6) is licensed in COPD
False
It is only the 100/6 that is licensed
90
What is the beclometasone (non-extra fine particles) equivalent of 100mcg Fostair (extra fine particles)?
250 mcg
Fostair is more potent as it contains extra fine particles
91
What combination is a Trimbow inhaler?
| What is it licenced In asthma or copd or both?
Beclometasone and formoterol and glycopyrronium
| COPD only
92
```
What dose of prednisolone would you expect for acute asthma attack for an adult?
A. 40-50mg 3 days
B. 10-20mg 3 days
C. 30-40mg 5 days
D. 40-50mg 3 days
E. 40-50mg 5 days
```
E 40 to 50mg for 5 days
93
True or false:
Symbicort 100/6 is licensed in COPD
False
Those licensed in COPD:
200/6
400/12
94
Is Flutiform licensed in COPD?
No
95
What is Trelegy licensed in?
| What combination is Trelegy?
COPD only
Fluticasone, umeclidinium and vilanterol
96
Mr DP is a 29yo man who has come to GP for migraine. GP wants to issue for migraine treatment for the patients symptoms. His current meds are;
○ levothyroxine 100mcg od
○ paracetamol 500mg 1-2 tabs up to qds prn
○ fostair 200/6 2 puffs bd
○ montelukast 10mg 1 tab on
Which if the following medications would be LEAST suitable to prescribe?
A. Topiramate
B. Pizotifen
C. Propranolol
D. Amitriptyline
C. Propranolol is a beta blocker. Asthmatic action of beta agonist can an be affected and asthma exacerbated.
97
Are any inhalers just containing ICS licensed in COPD?
No
| Recommended to prescribe ICS/LABA or trio inhaler as ICS monotherapy not recommended in COPD
98
What is a rare but serious side effect of montelukast?
Eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome - a disorder marked by blood vessel inflammation)
Has occurred very rarely with use of montelukast; in many of the reported cases the rxn followed the reduction or withdrawal of oral corticosteroid therapy. Prescribers should be alert to the development of eosinophilia, vasculitic rash, worsening pulmonary symptoms, cardiac complications, or peripheral neuropathy.
99
What are the side effects of aminophylline?
Arrythmia (more common if IV given too rapidly)
Headache
Nausea
Seizure (more common if IV given too rapidly)
May potentiate hypokalaemia in beta 2 agonist therapy
100
With IV aminophylline, when should a blood sample be taken?
4-6 hours after starting treatment
101
What is the ideal plasma concentration for theophylline?
10-20 mg/L - above this can lead to severe side effects
102
When would you measure plasma theophylline levels in a) starting oral therapy and
b) after a dose adjustment?
How many hours after an oral dose?
Measured 5 days after starting oral treatment and at least 3 days after any dose adjustment.
4-6 hours after
103
How does smoking interact with theophylline and how does this affect the dose needed?
Smoking can increase theophylline clearance and increased doses of theophylline are therefore required
104
What is the MHRA advice surrounding OTC chlorphenamine in children?
What about promethazine?
Children under 6 yrs should not be given OTC cough and cold medicines containing chlorphenamine
105
What is the MHRA advice surrounding hydroxyzine (sedating antihistamine)?
🇶🇦
QT prolongation
106
Theophylline interaction with;
Beta 2 agonists
Corticosteroids
Diuretics
Increased HYPOKALAEMIA risk
107
What drug class do you use to treat hereditary angiodema?
C1 esterase inhibitor
108
What is the 1st line mucolytic in CF?
What can be added if inadequate response?
Dornase alfa
Hypertonic sodium chloride
109
What is the MHRA advice surrounding OTC pholcodine in children?
Children under 6 years should not be given over-the-counter cough and cold medicines containing pholcodine
6-12 years- if needed, restrict to max 5 days
110
What are the symptoms of theophylline toxicity?
🤢 😠 😳 ❤ 🍬💓
```
Vomiting, and vomiting up blood
Agitation
Restlessess
Dilated pupils
Sinus tachycardia
Hyperglycaemia
Convulsions
Ventricular arrhythmias
Hypokalaemia
```
111
Should theophylline be prescribed by brand?
Yes as rate of absorption can vary between brands
112
How does theophylline interact with quinolones?
Increased risk of convulsions
113
How does theophylline interact with St John's Wort?
SCRAP GPSS
Theophylline concentration reduced by St John's Wort (enzyme inducer)
114
```
What electrolyte disturbance is most likely to occur with B2 agonist therapy?
A. Hyper natraemia
B. Hypo natraemia
C. Hypokalaemia
D. Hyperkalaemia
```
C.
Beta-2 agonists have been shown to decrease serum potassium levels via an inward shift of potassium into the cells due to an effect on the membrane-bound Na/K-ATPase, which can potentially result in hypokalemia. Beta-2 agonists also promote glycogenolysis, which can lead to inadvertent elevations in serum glucose
(Beta blockers cause higher potassium)
115
How does theophylline interact with cimetidine?
SICKFACES.COM
Theophylline concentration increased by cimetidine
116
```
Which of the following drugs is associated with narrow angle glaucoma?
A. Beclometasone dipropionate
B. Tiotropium
C. Vilanterol
D. Formeterol
```
A. Steroid
steroid inhalers
```
a sore mouth or throat.
a hoarse or croaky voice.
a cough.
oral thrush – a fungal infection that causes white patches, redness and soreness in the mouth.
nosebleeds.
```
Adverse effects such as adrenal suppression and osteoporosis are well documented. Less well recognised adverse effects include glaucoma, skin fragility, acne vulgaris and hirsutism.
117
How does theophylline interact with disulfiram?
Metabolism of theophylline is inhibited by disulfiram and therefore there is an increased risk of theophylline toxicity (hyperglycaemia, dilated pupils and haematemesis)
118
What type of inhaler is a Turbohaler?
DPI
119
What is the difference in Fostair Nexthaler and Fostair inhaler?
Nexthaler- DPI
| Fostair normal - pMDI
120
How do you calculate pack years?
(Number of cigs smoked a day/20) x number of years smoked
121
When should you refer a COPD patient for pulmonary rehabilitation?
If they are functionally disabled by COPD (usually Medical Research Council (MRC) dyspnoea scale grade 3 or above)
122
What is the purpose of pulmonary rehab for COPD patients?
- Can improve quality of life, increase exercise capacity safely and effectively, and reduce breathlessness.
- Programmes usually comprise 2–3 sessions/week and last for 6–12 weeks.
- Pulmonary rehabilitation should involve physical training; disease education; and nutritional, psychological, and behavioural interventions tailored to the person's needs.
123
Long term oxygen therapy prolongs life in COPD patients. How many hours a day at least must they be on oxygen?
15 hours
124
True or false:
In COPD, if a patient is regularly using a SAMA 4 times a day, a LAMA should be offered instead
True
?
125
What class of drug is bambuterol?
What formulation does it come in?
LABA
| Tablet
126
What age is QVAR inhalers licensed in?
12 years
127
What is the adrenaline dose in anaphylaxis in:
i) Children < 6 years
ii) Child 6-12 years
iii) > 12 years and adults
IM injection (1 in 1000 solution) repeated every 5 minutes if necessary.
Administer into thigh
i) Children < 6 years: 150 micrograms
ii) Child 6-12 years: 300 micrograms
iii) > 12 years and adults: 500 micrograms (For EpiPen brand it is 300 micrograms)
128
Patients on what medicine may not respond to adrenaline?
What could be an alternative
Beta blockers
IV salbutamol could be an alternative
129
What is the MHRA advice with adrenaline auto-injectors?
It is recommend that 2 adrenaline auto-injectors are prescribed, which patients should carry BOTH at all times.
Check expiry dates
130
What time of the day should LTRA be taken?
Evening
131
A patient requesting more than how many SABAs a month prompts a referral?
>1 a month
132
True or false:
Lung function measurements are used to guide asthma treatment of all ages
False
Not reliable in <5 years old
133
Are Ellipta inhalers DPI or MDI?
DPI
134
Can Clenil Modulite MDI be used in children?
| Is there any cut off age?
Yes - all ages
135
What type of inhaler is Clenil Modulite?
MDI
136
What type of inhaler is an Easyhaler?
DPI
137
What age is a a Beclometasone Easyhaler licensed in?
> 12 years
138
Can a Beclometasone Easyhaler be used in a 7 year old?
No
>12 years only
139
What age is a Qvar inhaler licensed in?
> 12 years
140
What type of inhaler is an Autohaler?
MDI
141
What age is Fostair licensed in?
> 18 years
142
What age is Pulmicort turbohaler licensed in?
5 years and over
143
What type of inhaler is a Turbohaler?
DPI
144
What age is Symbicort for maintenance therapy licensed in?
6 years and over
145
What age is Symbicort for maintenance AND reliever therapy licensed in?
12 years and over
146
What is the only strength Seretide Evohaler licensed in children and what is the cut off age?
25/50 licensed in children from 4 years
147
What are the 3 strengths of Seretide Evohaler?
25/50
25/125
25/250
148
What are the 3 Strengths of Seretide Accuhaler?
50/100
50/250
50/500
149
What is the only strength Seretide Accuhaler licensed in children and what is the cut off age?
50/100 licensed in children from 4 years
150
What are the 3 inhalers licensed in MART therapy and the ages they are licensed in?
Fostair 100/6 for 18 years + (This is NOT the nexthaler)
Symbicort 100/6 and 200/6 for 12 years +
Duoresp Spiromax 160/4.5 for 18 years +
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What is the inhaler that is shaped like an egg?
Spiriva Handihaler 18 micrograms tiotropium
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What does a whistling when a patient is using their inhaler mean?
They are breathing in too fast
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When should you issue a steroid card to a patient on an ICS?
If on high dose ICS
