Respiratory: Asthma

Question 1

In a child aged 2-5 years, what heart rate indicates Acute severe asthma?

Answer 1

> 140

Question 2

In a child aged 2-5 years, what resp rate indicates Acute severe asthma?

Answer 2

> 40

Question 3

In a child aged >5 years, what heart rate indicates Acute severe asthma?

Answer 3

> 125

Question 4

In a child aged >5 years, what resp rate indicates Acute severe asthma?

Answer 4

> 30

Question 5

In an adult, what heart rate indicates Acute severe asthma?

Answer 5

> =110

Question 6

In an adult, what resp rate indicates Acute severe asthma?

Answer 6

> =25

Question 7

In an adult, what PEFR indicates Acute severe asthma?

Answer 7

33-50%

Question 8

In a child >5, what PEFR indicates Acute severe asthma?

Answer 8

33-50%

Question 9

In an adult what O2 sats indicates life threatening asthma?

Answer 9

<92%

Question 10

Once asthma is controlled, how should it be monitored?

Answer 10

• 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.

Question 11

According to NICE, how should asthma be diagnosed in age 17 and over?

Answer 11

• 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.

Question 12

What is the FEV1/FVC ratio for obstructive result?

Answer 12

<70%
Or below the lower limit of normal

Question 13

What is a positive FeNO result in an adult ?

Answer 13

40 ppb or more

Question 14

What is a positive BDR test in an adult?

Answer 14

Improvement in FEV1 of >=12%, and increase in volume of >=200ml

Question 15

What is positive peak flow variability over 2-4 weeks?

Answer 15

variability >20%

Question 16

What is a positive result for a direct bronchail challenge test?

Answer 16

PC20 of 8mg/ml or less

Question 17

What is a positive FeNO test in children (5-16)?

Answer 17

35 ppb or more

Question 18

What is a positive BDR test result in children (5-16)?

Answer 18

Improvement in FEV1 of 12% or more

Question 19

According to NICE, what is the process of diagnosing asthma in children age 5-16?

Answer 19

• 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)

Question 20

8 steps

What is the stepwise managment of asthma according to NICE in adults?

Answer 20

1. SABA
2. Low dose ICS
3. Add LTRA
4. Add LABA (consider stopping the LTRA)
5. Change to MART
6. Increase ICS (within MART or fixed) to moderate dose
7. Increase ICS to high dose (within fixed only)
8. Refer to specialist (for theophylline/MRA)

Question 21

5 steps

What is the stepwise management of asthma in adults according to BTS?

Answer 21

1. SABA
2. Low dose ICS
3. Add LABA (fixed or MART)
4. Increase ICS to medium dose OR add LTRA (stop LABA if no response)
5. Refer to specialist

Question 22

7 steps

What is the stepwise management of asthma in children aged 5-16 according to NICE?

Answer 22

1. SABA
2. Paediatric low dose ICS
3. Add LTRA
4. Add LABA (consider stopping LTRA)
5. Change to MART regime
6. Increase ICS to paediatric moderate dose (within MART or fixed)
7. Refer to specialist (for paediatric high dose ICS or theophylline)

same as adult except refer earlier (after first increase in ICS)

Question 23

5 steps

What is the stepwise management of asthma in children aged 5-16 according to BTS?

Answer 23

1. SABA
2. Very low dose ICS
3. Add LABA or LTRA
4. Increase ICS to low dose OR add LTRA/LABA
5. Refer to specialist

Question 24

4 steps

What is the stepwise management of suspected asthma in children age <5 according to NICE?

Answer 24

1. SABA
2. 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
3. Add LTRA
4. Refer specialist and stop LTRA

Question 25

What is the stepwise management of suspected asthma in children age <5 according to BTS?

Answer 25

1. SABA
2. very low dose ICS OR LTRA
3. If on SABA and ICS, add the LTRA
4. Increase ICS to low dose
5. Refer specialist and stop the LTRA

Question 26

In which group is asthma under-diagnosed?

Answer 26

females

Question 27

Which tool should be used for annual review of asthma in children?

Answer 27

Childhood Asthma Control Test (which includes both child and parent report of symptoms)

or the Asthma Control Questionnaire

or Mini Asthma Quality of Life Questionnaire

or Paediatric asthma Quality of Life questionnaire

Question 28

How does occupational asthma develop?

Answer 28

• Most cases (approximately 90%) are caused by specific sensitisation to a workplace agent, rather than irritant induced occupational asthma
• several years can pass between onset of symptoms and diagnosis
• early recognition important to remove exposure to causative agent - improves the chances of clearing/improving the asthma