MSRA: Asthma

Question 1

What are the investigations for suspected asthma?

Answer 1

FENO testing + Spirometry with bronchodilator reversibility

Question 2

What are the steps of asthma management?

Answer 2

SABA
SABA + ICS
SABA + ICS + Montelukast

If no benefit from Montelukast: SABA + ICS + LABA

If some benefit from Montelukast: SABA+ ICS + Montelukast + LABA

Question 3

What are the features of a moderate asthma attack?

Answer 3

Peak flow 50-75%
No features of severe

Question 4

What are the features of a severe asthma attack?

Answer 4

Any one of the following:
Peak flow 33-50%
Respiratory rate >25
Heart rate >110
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Question 5

What are the features of a life-threatening asthma attack?

Answer 5

Any one of the following:
Peak flow less than 33%
Sats < 92%
Normal CO2
Exhaustion, silent chest

Question 6

What is the management of an acute asthma attack?

Answer 6

Oxygen
Nebulised salbutamol
Steroids

Consider nebulised ipratroprium

Other options:
IV Magnesium sulphate
IV Aminophylline

Question 7

What is the criteria for discharge following an asthma attack?

Answer 7

Stable on regular medication for 24 hours
Peak flow >75%
Inhaler technique checked and recorded

Question 8

What is the guidance for stepping down inhaled corticosteroids?

Answer 8

Aim for a dose reduction of 25 to 50%