Chronic Asthma

Question 1

How often should a patient have an asthma review?

Answer 1

Every 3 months

Question 2

Under which circumstances would you step up on the asthma scale?

Answer 2

• If you are using inhaler or are symptomatic > or = 3 times a week
• If you have night time symptoms > or = once a week
• If you have had an asthma attack requiring oral steroids in the last 2 years

Question 3

When would you refer?

Answer 3

• If the patient has used inhaler up < 1 month

Question 4

What is the step up/down response to chronic asthma?

Answer 4

Step 1 - ICS (low dose)

Step 2 - ICS (low dose) + LABA

Step 3 - Increase ICS dose + stop LABA, Increase ICS dose + continue LABA, ICS + LABA + trial LTRA, SR Theophylline, LAMA

Step 4 - Increase ICS (high dose) + 4th drug (LTRA, SR theophylline, LAMA, B2 agonist)

Step 5 - Oral daily prednisolone

Question 5

What are the SABA/LABA side effects?

Answer 5

• decrease K+
• Hyperglycaemia
• Hand tremors
• Tachycardia
• Arrhythmias - QT prolongation (low K+)

Question 6

What are the ICS side effects? (can take 3-4 weeks to work)

Answer 6

• Hoarse voice
• Sore throat
• Oral thrush - rinse mouth after spacer use, treat with daktarin (miconazole gel)
• parodoxical bronchospasm - stop + give alternative

Question 7

When would you use a large volume spacer?

Answer 7

• For higher doses of ICS

- < 15 years old

Question 8

What are the side effects of LTRA?

Answer 8

• Churg strauss syndrome - Oesinophilia, vasculitic rash, peripheral neuropathy
• Liver toxicity - with zafirlukast

Question 9

What is the range for theophylline?

Answer 9

10 - 20 mg/L

Question 10

What are signs of theophylline toxicity?

Answer 10

• vomiting, diarrhoea
• tachycardia, restlessness, agitation
• arrhythmias, convulsions, decrease K+
• dilated pupils

Question 11

Interactions of theophylline?

Answer 11

• B2 agonists, corticosteroids, diuretics = Increase K+
• Quinolones, mefloquine, antipsychotics, macrolides, tramadol, antidepressants, amiodarone = Increase Convulsions
• CCB, cimetidine, isoniazid, inhibitors = Increase plasma conc
• Inducers, smoking, alcohol = Decrease Cp

Question 12

How would you respond to an asthma medical emergency (acute asthma)?

Answer 12

• Salbutamol aerosol via spacer - 2-10 puffs every 10-20 mins PRN

OR

• SABA nebuliser - every 20-30 mins PRN

If symptoms persist, repeat and add nebulised ipratropium

Question 13

What do you give as a follow up in all cases of acute asthma?

Answer 13

• Prednisolone 40-50mg OD for 5 days OR IV hydrocortisone
• For children under 12 = less than 2 days treatment
• Increase oxygen flow if available