Respiratory: Asthma Flashcards
In a child aged 2-5 years, what heart rate indicates Acute severe asthma?
> 140
In a child aged 2-5 years, what resp rate indicates Acute severe asthma?
> 40
In a child aged >5 years, what heart rate indicates Acute severe asthma?
> 125
In a child aged >5 years, what resp rate indicates Acute severe asthma?
> 30
In an adult, what heart rate indicates Acute severe asthma?
> =110
In an adult, what resp rate indicates Acute severe asthma?
> =25
In an adult, what PEFR indicates Acute severe asthma?
33-50%
In a child >5, what PEFR indicates Acute severe asthma?
33-50%
In an adult what O2 sats indicates life threatening asthma?
<92%
Once asthma is controlled, how should it be monitored?
- personalised asthma action plan
- If using ICS in a single inhaler - increase dose when control worsens - quadruple the dose for 7 days in children >5 and adults. (Do not exceed the maximum age specific licensed daily dose of ICS)
- decrease maintenance therapy once asthma been controlled for 3 months.
- At every review consider:
- Adherence.
- Inhaler technique.
- If treatment needs to be changed.
- Occupational asthma.
- Using a validated questionnaire.
- Monitor control using peak flow readings or spirometry.
- Do not use FeNO to monitor asthma.
According to NICE, how should asthma be diagnosed in age 17 and over?
- spirometry then bronchodilator reversibility (BDR): if both positive = asthma
*if either are negative - check FeNO level. - If FeNO is positive, and PEFR variability over 2-4 weeks is positive = asthma
- if uncertainty - refer to specialist for direct bronchial challenge.
What is the FEV1/FVC ratio for obstructive result?
<70%
Or below the lower limit of normal
What is a positive FeNO result in an adult ?
40 ppb or more
What is a positive BDR test in an adult?
Improvement in FEV1 of >=12%, and increase in volume of >=200ml
What is positive peak flow variability over 2-4 weeks?
variability >20%
What is a positive result for a direct bronchail challenge test?
PC20 of 8mg/ml or less
What is a positive FeNO test in children (5-16)?
35 ppb or more
What is a positive BDR test result in children (5-16)?
Improvement in FEV1 of 12% or more
According to NICE, what is the process of diagnosing asthma in children age 5-16?
- spirometry then BDR. If both positive = asthma
- FeNO if either spiro or BDR are negative
- PEFR variability for 2-4 weeks.
- If FeNO and PEFR positive = asthma
- if one of FeNO or PEFR is positive, but other negative - suspect asthma and review diagnosis after treatment. (Do NOT refer for direct bronchial challenge)
8 steps
What is the stepwise managment of asthma according to NICE in adults?
- SABA
- Low dose ICS
- Add LTRA
- Add LABA (consider stopping the LTRA)
- Change to MART
- Increase ICS (within MART or fixed) to moderate dose
- Increase ICS to high dose (within fixed only)
- Refer to specialist (for theophylline/MRA)
5 steps
What is the stepwise management of asthma in adults according to BTS?
- SABA
- Low dose ICS
- Add LABA (fixed or MART)
- Increase ICS to medium dose OR add LTRA (stop LABA if no response)
- Refer to specialist
7 steps
What is the stepwise management of asthma in children aged 5-16 according to NICE?
- SABA
- Paediatric low dose ICS
- Add LTRA
- Add LABA (consider stopping LTRA)
- Change to MART regime
- Increase ICS to paediatric moderate dose (within MART or fixed)
- Refer to specialist (for paediatric high dose ICS or theophylline)
same as adult except refer earlier (after first increase in ICS)
5 steps
What is the stepwise management of asthma in children aged 5-16 according to BTS?
- SABA
- Very low dose ICS
- Add LABA or LTRA
- Increase ICS to low dose OR add LTRA/LABA
- Refer to specialist
4 steps
What is the stepwise management of suspected asthma in children age <5 according to NICE?
- SABA
- 8 week trial paediatric moderate dose ICS. Stop. If did not resolve - alternative diagnosis. If resolved and reoccurred <4 weeks - start paed low dose ICS maintenance. If resolved and recurred >4 weeks - repeat the 8 week trial
- Add LTRA
- Refer specialist and stop LTRA
