Respiratory System - Medium

Question 1

Outline the treatment pathway for management of chronic asthma in adults

Answer 1

1- Intermittent reliever therapy
SABA reliever inhaler

2- Regualr preventer (maintenance) therapy
Low dose ICS to anyone who is using reliever/symptomatic more than 3 times weekly or waking in the night due to symptoms

3- Initial add-on therpy
NICE - Addition of LTRA (montelukast)
BTS - LABA as a single inhaler or as MART (beclometasone and formeterol)

4- Additional controller therapies
NICE - addition of LABA as single inhaler or MART with or without LTRA - if still uncontrolled there is potential for addition of tiotropium or theophylline
BTS - Dose of ICS increased or LTRA added

Question 2

Outline the treatment pathway for management of chronic in children

NICE defines treatment in children as those 5 - 16 years old
BTS defines treatment in children as those 5 - 12 years old

Answer 2

1- Intermittent reliver therapy
SABA reliever inhaler

2- Regular preventer (maintenance) therapy
Paediatric low-dose ICS to anyone who is using reliever/symptomatic more than 3 times weekly or waking in the night due to symptoms

3- Initial add-on therapy
NICE - Addition of LTRA (montelukast)
BTS - **LABA as single inhaler or as MART **(budesonide with formeterol) or LTRA (very low-dose ICS)

4- Additional controller therapies
NICE - Discontinue LTRA and start LABA as single inhaler or as MART
BTS - Continue LABA or LTRA and either increase dose of ICS or add LABA or LTRA (whichever is not being used)

Question 3

Outline the treatment pathway for management of chronic asthma is children under 5 years of age

Answer 3

1- Intermittent reliever therapy
SABA reliever inhaler

2- Regular preventer (maintenance) therapy
NICE - 8 week trial of paediatric moderate dose ICS; after 8 weeks if symptoms have not resolved consider alternative diagnosis, if symptoms did resolve but restarted within 4 weeks start paediatric low-dose ICS
BTS - Start very low-dose ICS or LTRA if ICS not appropriate

3- Initial add-on therapy
NICE - Start LTRA in addition to ICS - if asthma is still uncontrolled stop LTRA and refer

Question 4

Which drugs for the treatment of asthma should be withheld during pregnancy?

Answer 4

None
ICSs, SABAs, LABAs, theophylline, and even LTRAs can be used in pregnancy to maintain tight control of asthma symptoms during pregnancy

Question 5

What are the peak low readings that indicate moderate, severe, and life-threatening asthma in adults?

Answer 5

Moderate > 50-75%
Severe 33-50%
Life-threatening <33%

Question 6

How is acute asthma managed in adults?

Answer 6

SABA (nebulised in severe/life-threatening asthma)
Prednisolone 40mg OD 5 days
Possibly ipratropium nebs in severe/life-threatening asthma
Possibly magnesium sulfate

Question 7

How is acute asthma managed in children older than 2 years?

Answer 7

SABA (nebulised in severe/life-threatening
Prednisolone 1-2mg/kg (max 40mg) 3 days
Possibly ipratropium nebs in severe/life-threatening asthma
Possibly magnesium sulfate

Question 8

How is acute asthma managed in children younger than 2 years?

Answer 8

Nebulised SABA
Prednisolone 1-2mg/kg (Max 40mg) 3 days
Ipratroium nebs

Question 9

Outline the treatment pathway for the management of COPD

Answer 9

Initial management
SABA or SAMA

Step-up treatment in those without asthmatic features
Discontinue SAMA and offer LAMA and SABA (SABA can continue to used at all stages)
Consider addition of ICS

Step-up treatment in those with asthmatic features
LABA and ICS
Consider addition of LAMA (discontinue SAMA if being used)

Question 10

How are exacerbations of COPD managed?

Answer 10

Drug treatment
SABA or SAMA (without regular LAMA if SAMA used)
Short course prednisolone 30mg
Amoniphylline can be used if anedequate resposne to SABA/SAMA

Patients may be on prophylactic dose of azithromycin - this can be continued during treatment for exacerbation.
Patients may also have rescue packs at home containing doxycycline and prednisolone.

Question 11

Should neubilsers be driven with air or oxygen in patients with COPD?

Answer 11

Air

Question 12

Should nebulisers be driven with air or oxygen in patients with asthma

Answer 12

Oxygen

Question 13

Name a drug used to alter sputum viscocity in COPD

Answer 13

Carbocisteine (1.5g daily)

Question 14

Which drugs can be used for cough suppression?

Answer 14

Dextromorphan
Pholcodine
Sedating antihistamines

Question 15

Which drug is used for cough suppression in a palliative care setting?

Answer 15

Diamorphine hydrochloride

Question 16

Compound preparations for the treatment of cannot be used in children below what age?

Answer 16

6yrs

Question 17

Name a demulcent cough preparation

Answer 17

Simple lintus

Question 18

Name an expectorant cough medicine

Answer 18

Guaifenesin

Question 19

Which oral medications are available over the counter to treat nasal congestion?

Answer 19

Pseudoephedrine

Question 20

Dextromorphan should be avoided in children under what age?

Answer 20

12yrs

Question 21

Which drugs for cough and congestion cannot be given to children under the age of 6?

Answer 21

Antihistamines: Brompheniramine, chlorphenamine, diphenydramine, doxylamine, promethazine, triprolidine

Expectorants: Guaifenesin, ipecacaunha

Cough suppressants: Dextromorphan, pholcodine

Decongestants: Phenylephrine, pseudoephrine, ephedrine, oxymetazoline, xylometazoline

Question 22

What dose of salbutamol is licensed for treatment of moderate, severe, and life-threatening asthma in children aged 1 months - 4 years of age?

Answer 22

2.5mg every 20 - 30mins

Question 23

What dose of salbutamol is licensed for the treatment of moderate, severe, and life-threatening asthma in children aged 5 - 11 years?

Answer 23

2.5 - 5mg every 20 - 30mins

Question 24

What dose of salbutamol is licensed for the treatment of moderate, severe, and life-threatening asthma in children aged 12 - 17 years?

Answer 24

5mg every 20 - 30mins

Question 25

How should theophylline be prescribed?

Answer 25

By brand