Important

Question 1

What classes ‘moderate asthma exacerbation’?

Answer 1

PEF >50-75% predicted with increasing symptoms but no signs of acute asthma

Question 2

What classes ‘acute severe asthma?’

Answer 2

Any one of: - PEF 33-50% predicted - RR>25/min - HR >110/min - Inability to complete sentences in one breath

Question 3

What classes ‘life threatening asthma’?

Answer 3

Any one of the following seen in acute severe patients: - Altered conscious level - Exhaustion - Arrhythmia - Hypotension - Cyanosis - Silent chest - Poor respiratory effort - PEF

Question 4

What classes ‘near fatal asthma’?

Answer 4

Raised PaCO2 and/or requiring mechanical ventilation with raised inflation pressures

Question 5

**What are the steps in the pharmacological management of asthma?

Answer 5

Step 1 Intermittent: SABA

Step 2 Mild Persistent: SABA + ICS

Step 3 Moderate Persistent: SABA + ICS + LABA

Step 4 Severe Persistant: SABA + ICS + LABA + add on drug eg. cyst-leukotriene receptor antagonists, theophylline or B2 agonist tablet

Step 5: all of these + oral steroids

Question 7

What are the main pharmacological treatments of COPD?

Answer 7

Step 1: SABA/SAMA

Step 2: if FV1 is >60% then LABA or LAMA ; if it is

Step 3: LABA/combined inhaler or LAMA + LABA + ICS

Question 8

How would you treat acute asthma exacerbation?

Answer 8

• Oxygen (60%)
• Nebulised high dose salbutamol (2.5-5mg)
• Hydrocortisone (oral) 100mg
• Ipitropium 500mcg nebuliser
• Theophylline: aminophylline infusion
• Magnesium sulphate 2g IV
• Escalate to mechanical intubation if going into respiratory failure

Question 10

How would you treat acute COPD

Answer 10

• Nebulised high dose ipratropium
• Nebulae high dose salbutamol
• Oxygen
• Amoxicillin if infective
• Oral prednisolone