Respiratory

Question 1

-How often should spacers be cleaned?

Answer 1

Once a month

Question 2

-How often should spacers be replaced?

Answer 2

Every 6 to 12 months

Question 3

-Outline inhaler devices used in children under 5?

Answer 3

• pMDI and spacer with or without spacer should be used for ICS and bronchodilators
• If that is unsuitable can use nebulised therapy
• Children over 3 may try DPIs

Question 4

-Outline inhaler devices used in 5 to 15 year old?

Answer 4

• CCS should be delivered by pMDI and spacer

- For other therapy, a broader range of devices can be considered

Question 5

Outline the potency of ICS

Answer 5

• Fostair is most potent
• QVAR is next most potent
• Clenil, etc lower potency

Question 6

What is complete control of asthma described as?

Answer 6

• No daytime symptoms
• No night-time waking due to asthma
• No asthma attacks
• No need for rescue medication
• No limitations on activity such as exercise
• Normal lung function (FEV1/PEF >80%)
• Minimal side effects

Question 7

What would peak flow be in moderate acute asthma?

Answer 7

-50-75%

Question 8

What would peak flow be in severe acute asthma?

Answer 8

-33-50%

Question 9

What would peak flow be in life threatening acute asthma?

Answer 9

-Less than 33%

Question 10

How is acute asthma managed in the community?

Answer 10

• 2-10 puffs of salbutamol every 10 to 20 mins or prn
• If symptoms persist after 15-30 mins call 999
• In hospital repeat above but also give nebulised ipratropium, consider IV magnesium sulphate
• Give oral prednisolone 40-50mg for at least 5 days in adults and for 3 days if under 12

Question 11

What prednisolone regimen is used in AECOPD?

Answer 11

-30mg daily for 7-14 days

Question 12

Outline the steps of asthma treatment in adults recommended by BTS/SIGN

Answer 12

1) Low dose ICS
2) Low dose ICS + LABA
3) Increase ICS to medium dose or add LTRA
4) Refer

Question 13

Outline the steps of asthma treatment in adults (>17yo) recommended by NICE

Answer 13

1) Low dose ICS
2) Low dose ICS + LTRA
3) Low dose ICS + LABA with or without LTRA
4) Consider MART regimen or increase ICS dose
5) Additional drug/refer

Question 14

Outline the steps of asthma treatment in children >5yo recommended by BTS/SIGN

Answer 14

1) Very low dose ICS
2) Very low ICS dose + LABA or LTRA
3) Increase ICS to low dose or add LABA or LTRA (Whichever was not added in step 2)
4) Refer

Question 15

Outline the steps of asthma treatment in children 5-16yo recommended by NICE

Answer 15

1) Low dose ICS
2) Low dose ICS + LTRA
3) Low dose ICS + LABA (stop LTRA)
4) Consider MART or increasing ICS dose
5) Additional drug/refer

Question 16

Outline the steps of asthma treatment in children <5yo recommended by BTS/SIGN

Answer 16

1) LTRA
2) LTRA + very low dose ICS
3) Increase ICS to low dose
4) Refer

Question 17

Outline the steps of asthma treatment in children <5yo recommended by NICE

Answer 17

1) 8 week trial of moderate dose ICS, if benefit prescribe low dose ICS
2) Low dose ICS + LTRA
3) Stop LTRA and refer

Question 18

Outline the steps of COPD management

Answer 18

1) SABA or SAMA
2) LABA + LAMA if no asthmatic features OR LABA + ICS if asthmatic features
3) LABA + LAMA + ICS