Chronic Asthma

Question 1

What is the presentation of asthma?

Answer 1

• cough: often worse at night
• dyspnoea
• ‘wheeze’, ‘chest tightness’
• expiratory wheeze on ausculation
• reduced PEFR

Question 2

What investigations are done to confirm asthma?

Answer 2

Spirometry:
>FEV1 - significantly reduced
>FVC - normal
>FEV1% (FEV1/FVC) < 70%

Fractional exhaled nitric oxide
>nitric oxide is produced by 3 types of nitric oxide synthases (NOS).
>one of the types is inducible (iNOS) and levels tend to rise in inflammatory cells, particularly eosinophils
>levels of NO therefore typically correlate with levels of inflammation.

In older/Hx of smoking do CXR

Question 3

What is the first line medication for asthma in adults?

Answer 3

SABA

>Salbutamol inhaler (PRN up to 10 puffs)

Question 4

What is the second line treatment for asthma in adults?

Answer 4

Add in inhaled steroids to SABA

>Beclometasone (taken once a day AM)

Question 5

What is the third line treatment for asthma in adults?

Answer 5

Add in a leukotriene receptor to SABA and inhaled steroid
>Montelukast
(review 4-8weeks later)

Question 6

What is the 4th line treatment for asthma in adults?

Answer 6

Add a LABA
or
Add in a MART (maintenance and reliver therapy)
-Combined ICS and LABA in single inhaler
-used daily

Question 7

If asthma is uncontrolled in adults on a MART regimen with a low maintenance ICS dose, with or without an LTRA?

Answer 7

Consider increasing steroid dose

Question 8

If asthma is uncontrolled in adults on a moderate maintenance ICS dose with a LABA (either as MART or a fixed-dose regimen), with or without an LTRA, consider what?

Answer 8

• Max steroid dose

* additional specialist involvement