Management principles

Question 1

Five big advances in the management of asthma

Answer 1

1. The realisation that asthma is an inflammatory disease.
   * Therefore, the appropriate first-line Rx in moderate to severe asthma is inhaled cromolyn or corticosteroids.
2. Regular monitoring with spirometry.
3. The use of spacers attached to inhalers/puffers for all ages.
4. Improved and more efficient inhalers, such as Turbuhalers.
5. The availability of long-acting steroids and B2-agonists, inc. a combination of these agents.

Question 2

Definition of good control of asthma

Answer 2

Minimal symptoms during day and < 2 days a week

No nocturnal waking due to asthma

No limitation of physical activity

Minimal need for reliever medication

No overuse of β2-agonist

No exacerbations

No side-effects of medication

Normal lung function FEV1 ± PEFR >80% predicted of best

Question 3

Definition of levels of recent asthma control in adults and adolescents (regardless of current treatment regimen).

Answer 3

Question 4

Clinical features associated with increased risk of severe exacerbations and mortality.

Answer 4

Question 5

Asthma action plan (example)

Answer 5

If you are distressed with severe asthma:

Call an ambulance and say ‘severe asthma attack’ (best option) or

Call your doctor or

If you are having trouble finding medical help, get someone to drive you to the nearest hospital

Follow the ‘4 × 4 × 4’ rule with reliever medication but keep using your bronchodilator inhaler continuously if you are distressed

Question 6

Asthma First Aid Action Plan

Answer 6

• Name —
• Contact Dr —————Tel ———
• Ambulance tel—————————

1. Sit upright and stay calm.
2. Take 4 separate puffs of a reliever puffer (one puff at a time) via a spacer device.

• Just use the puffer on its own if you don’t have a spacer.
• Take 4 breaths from the spacer after each puff.

3. Wait 4 minutes.
   * If there is no improvement, take another 4 puffs.
4. If little or no improvement

CALL AN AMBULANCE IMMEDIATELY

(DIAL 000 and/or 112 from mobile phone) and state that you are having an asthma attack.

Keep taking 4 puffs every 4 minutes until the ambulance arrives.

See your doctor immediately after a serious asthma attack.

Question 7

Using a spacer device

Answer 7

Rules:

children—single puffs then 4 or 5 breaths (repeat after several seconds if necessary)

adults—single puff, 1–4 deep breaths

Question 8

Delivery systems for asthma in children by age

Answer 8

Nebuliser/air compressor/face mask, any age

Inhaler + spacer + face mask or aerochamber, 0-4 yrs

Inhaler + spacer, > 2yrs

Inhaler alone, > 7yrs

Turbuhaler, > 7yrs

Spincaps, > 7yrs

Rotacaps, > 7yrs

Question 9

Stepwise approach for adjusting asthma medication in adults.

Adapted from NPS Medicine Wise

Answer 9

Question 10

Treatable traits in asthma

Answer 10