[GP] Asthma

Question 1

what is symptomatic asthma defined by?

Answer 1

• using SABA ≥3/week
• asthma sx ≥3/week
• nocturnal sx ≥1/week

Question 2

what is the 1st line ix for asthma?

Answer 2

clinical dx; can use spirometry to confirm

Question 3

what is the initial mx for asthma?

Answer 3

SABA +/- ICS
(reassess every 4-8 weeks)

SABA = short acting beta2 agonist (Salbutamol)
ICS = inhaled corticosteroid (Flucatisone)

Question 4

what is the next step if still symptomatic despite SABA +/- ICS?

Answer 4

low dose ICS + LTRA

LTRA = leukotriene receptor antagonist (Montelukast)

Question 5

what is the next step if pt shows a good response to low dose ICS + LTRA?

Answer 5

low dose ICS, LTRA + LABA

LABA = long acting beta2 agonist (Salmeterol)

Question 6

what is the next step if still symptomatic despite low dose ICS, LTRA + LABA?

Answer 6

medium dose ICS, LTRA, LABA

Question 7

what is the next step if pt does not show a good response to low dose ICS + LTRA?

Answer 7

low dose ICS + LABA

Question 8

what is the next step if still symptomatic despite low dose ICS + LABA?

Answer 8

medium dose ICS, LABA

Question 9

what is the next step if still symptomatic despite medium dose ICS, LABA +/- LTRA?

Answer 9

get specialist help

Question 10

what is moderate asthma?

Answer 10

peak flow >50-75% of best

Question 11

what is severe asthma?

Answer 11

peak flow 33-50% of best

Question 12

what is life-threatening asthma?

Answer 12

peak flow <33% of best

Question 13

what is near-fatal asthma?

Answer 13

raised PaCO2 ≥6 kPa

Question 14

what are the features of severe asthma?

Answer 14

• RR ≥25/min
• HR ≥110bpm
• inability to complete sentences in one breath

Question 15

what are the features of life-threatening asthma?

Answer 15

• poor respiratory effort
• silent chest
• cyanosis
• arrhythmia
• hypotension

Question 16

what is needed for near-fatal asthma?

Answer 16

need for mechanical ventilation with raised airway pressures

Question 17

how do you manage moderate asthma?

Answer 17

• manage in primary care dependent on response to treatment

- steroids: prednisolone 30mg OD

Question 18

how do you manage severe/life-threatening asthma?

Answer 18

1. manage in hospital
2. nebulised salbutamol 5mg
3. add nebuliser ipratropium bromide 500mcg
4. IV magnesium sulphate 2g over 20 mins

steroids:

• prednisolone 30mg OD
• hydrocortisone 100mg IV

Question 19

how do you manage near-fatal asthma?

Answer 19

1. ICU referral
2. all measures as for severe/life-threatening
3. IV aminophylline
4. intubation and ventilation

steroids: hydrocortisone 100mg IV

Question 20

asthma, eosinophilia, pANCA. dx?

Answer 20

Churg-Strauss syndrome

Question 21

obesity, T2RF, OSA. dx?

Answer 21

obesity hypoventilation syndrome

Question 22

asthmatic, pCO2 ≥6.5. dx?

Answer 22

near fatal asthma attack