Chronic asthma

Question 1

Symptoms of asthma

Answer 1

cough
wheezing
chest tightness
SOB

Question 2

Complete control of asthma is defined as:

Answer 2

no daytime symptoms, no night-time awakening due to asthma, no asthma attacks, no need for rescue medication, no limitations on activity including exercise, normal lung function (in practical terms forced expiratory volume in 1 second (FEV1) and/or peak expiratory flow (PEF) > 80% predicted or best), and minimal side-effects from treatment

Question 3

lifestyle changes to improve asthma control

Answer 3

Weight loss in overweight patients may lead to an improvement in asthma symptoms. Patients with asthma and parents of children with asthma should be advised about the dangers of smoking, to themselves and to their children, and be offered appropriate support to stop smoking.

Breathing exercise programmes (including physiotherapist-taught methods and audiovisual programmes), can be offered to adults as an adjuvant to drug treatment to improve quality of life and reduce symptoms.

Question 4

NICE guidelines

adult (17 and over)

Answer 4

SABA-
low dose ICS -

ICS +LTRA

then :
ICS +/- LTRA + LABA (depending on benefit of LTRA)

then  MART (low dose ICS and  fast acting LABA combo 
)

Question 5

NICE (5-16)

Answer 5

SABA - paed low dose ICS + paed low dose ICS and LTRA

add on therapies:

Paed ICS and LABA
MART
Paed moderate ICS and LABA or MART

PAed High dose ICS +LABA or Additional drug (theophylline)

Question 6

example of fast acting LABA

Answer 6

formeterol

Question 7

what additional drugs are used for severe uncontrolled asthma?

Answer 7

MR theophylline or a LAMA e.g. tiatropium

Question 8

adult BTS: what indicates a low dose ICS (regular preventer therapy)

Answer 8

using SABA/symptomatic 3time a week, or awake from asthma 1 night a week

Question 9

adult BTS pathway

Answer 9

low dose ICS - Low dose ICS and LABA
(fixed dose or MART)

additional therapies:

medium dose LABQA or low dose ICS and LABA and LTRA
or medium dose
ICS

or Low dose ICS ad LTRA

specialist:

High dose ICS and LABA LTRA
or medium dose ICS and LTRA theophylline/tiatropium

Question 10

BTS under 12

Answer 10

very low doseICS or LTRA if older than 5 years

Question 11

When would you decrease asthma treatment

Answer 11

hen a patient’s asthma has been controlled with their current maintenance therapy for at least three months. When deciding which drug to decrease first and at what rate, the severity of asthma, the side-effects of treatment, duration on current dose, the beneficial effect achieved, and the patient’s preference should be considered. Patients should be regularly reviewed when decreasing treatment.