Respiratory

Question 1

Define Asthma

Answer 1

Chronic inflammation. Associated with increase in airway hyper responsiveness. This leads to recurrent episodes of wheezing, breathlessness

Question 2

List the symptoms associated with asthma and when does it happen?

Answer 2

Breathlessness
Chest Tightness
Coughing
Wheezing

Particularly at night or early in the morning.

Question 3

How is asthma diagnosed?

Answer 3

• Medical history
• Physical Examination (lung function test)
  FEV1/FVC ratio determines diagnosis.
• Symptoms

Question 4

What is FEV1 and FVC?

Answer 4

FEV1: the volume of air that the patient is able to exhale in the first second of the forced expiration

FVC: The total volume of air that the patient can forcibly exhale in one breath.

Question 5

What are the aims of Pharmacological treatment in Asthma?

Answer 5

Aims of Asthma Treatment:

• Normal lung function of 80%
• No exacerbation
• No symptoms

Question 6

State things that can trigger asthma:

Answer 6

Asthma is triggered by:

• Specific allergens
• Air pollution
• Smoke
• Beta-blockers
• NSAIDs

Question 7

Whats first line in Asthma? Gimme specifics and alternatives to the first line treatment.

Answer 7

First line is SABA (Salbutamol MDI 100mcg 2 doses PRN)

Or Terburtaline 500mcg 1 dose PRN

Question 8

When would you prescribe ICS in Asthma

Answer 8

Prescribe ICS for asthmatics as a preventer therapy for people who:

• Use SABA 3x or more
• Have symptoms of asthma 3x per week or more
• Are awoken by asthma at night once weekly or more.

Question 9

State 3 examples of ICS

Answer 9

Clenil MDI (beclomethasoe) 100mcg-200mcg 2 doses BD

Pulmicort Tubohaler
(budesonide) 100-200mcg 2 doses BD

Flixotide MDI (fluticasone) 50-100mcg BD

Question 10

So! An Asthma patient has ICS and SABA. This isn’t effective. Whats Third line?

Answer 10

LABA - Long acting Beta agonist. E.g Salmeterol.

ICS + LABA = Seretide,

Question 11

If an asthma patient is taking ICS and LABA and it isn’t working, what next?

Answer 11

Stop the LABA and give LAMA e.g tiotropium.

You can give theophylline if needed

Question 12

What is the difference between COPD and Asthma?

Answer 12

airway obstruction is largely irreversible in COPD. Patients also continue to experience progressive lung function deterioration. It

Question 13

What is the FEV1/FVC ratio in COPD

Answer 13

less than 0.7

Question 14

What is first line in COPD?

Answer 14

Inhaled bronchodilators (SABA) or SAMA. e.g Salbutamol (SABA)

Ipatropium bromide (SAMA)

Question 15

If first line therapy of COPD does not work, then what?

Answer 15

Give a LABA e.g Salmeterol or Formeterol.

Or a LAMA e.g Tiotropium The first line SAMA must be discontinued.

Then give an ICS

Question 16

FEV1 Stage 1 is

Answer 16

80%

Question 17

FEV1 Stage 2 is

Answer 17

50-79% Mild FEV1

Question 18

FEV1 Stage 3 is

Answer 18

30-49% Moderate FEV1

Question 19

FEV1 Stage 4 is

Answer 19

less than 30% Severe FEV1