Respirology

Question 1

meds that trigger asthma

Answer 1

NSAIDs, ASA (10-20% of asthmatics)
Beta blockers (non-cardioselective)

Question 2

Asthma Dx criteria for 1-5 yo

Answer 2

All 3 of the following during at least 2 episodes:

• Airflow obstruction (cough, diff breathing, wheeze)
• Reversibility (with SABA or steroid)
• No evidence of other Dx

Question 3

Asthma Dx criteria for >5 yo

Answer 3

Must have spirometry (or methacholine or exercise challenge)

FEV1/FVC < 0.8 (0.8-0.9 for kids 6+yo; 0.75-0.8 for adults)
FEV1/FVC improve by 12% with bronchodilator
or
PEF improve by 20% with broncho dilator

Question 4

Evidence of adequate asthma control

Answer 4

Daytime symptoms <4 days per week
Night symptoms <1 night per week
Exacerbations are mild and infrequent
No absence from work/school
Ventolin <4 doses per week
FEV1 or PEF >90% of personal best
sputum eosinophils <2-3%

Question 5

Asthma maintenance meds for 1-5 yo

Answer 5

SABA and ICS (increase ICS if inadequate)

Question 6

Child with asthma: when to refer?

Answer 6

1-5 yo with 2+ exacerbations needing PO steroids
1-5 yo with 8+ symptom days per month despite moderate ICS
6-11 yo failing to control adequately with medium dose ICS

Question 7

PRAM score for asthma exacerbation in children <6yo.

What elements are included?

Answer 7

SaO2
Suprasternal retractions
Scalene contraction 
Air entry
Wheeze

Question 8

Treatment of mild asthma exacerbation in 6-11 yo

Answer 8

If only taking SABA prn: start regular ICS

If already taking ICS or ICS/LABA:
- Dexamethasone 0.15-0.6 mg/kg x 1-2 days
or
- Prednisone 1mg/kg x 3-5 days

Question 9

Treatment of mild asthma exacerbation in 12+ yo

Answer 9

If only taking SABA prn: start regular ICS

If already taking ICS or ICS/LABA:
- Increase ICS 4-fold (or up Symbicort to 4 puffs BID) x 7-14 days
or
- Prednisone 30-50 mg x 5+ days

Question 10

Dx criteria for COPD

Answer 10

FEV1/FVC < 0.7 (or below lower limit of normal)

irreversible or only partially reversible with bronchodilator

Question 11

Vaccination for COPD

Answer 11

Annual influenza
Pneumococcal (booster at 5 years)
(COVID!)

Question 12

Meds for mild COPD

Answer 12

1: SABA or SAMA (atrovent) prn
2: LAMA (Spiriva) [preferred over LABA]

Question 13

Meds for mod-severe COPD

1st, 2nd and 3rd line

Answer 13

Low risk of exacerbations:

1: LAMA (Spiriva) + (everyone gets SABA or SAMA prn)
2: LAMA+LABA (Ultibro)
3: LAMA+LABA+ICS (e.g. Spiriva + Symbicort; Spiriva + Breo)

High risk of exacerbations (2 mod or 1 severe AECOPD in 1y)

1: LAMA+LABA [if high eosinophils or asthma, consider ICS+LABA)
2: LAMA+LABA+ICS
3: PO therapies (macrolides, roflumilast, NAC)

Question 14

5 A’s of smoking cessation

Answer 14

Ask if pt smokes
Advise to stop 
Assess willingness
Assist in attempts to stop
Arrange f/u

Question 15

Prescriptions for smoking cessation

Answer 15

1: NRT (combination better than mono; e.g. patch + gum)
1: Varenicline; 0.5 OD x3d, then 0.5 BID x4 d, then 1mg BID x 3 months

2: Bupropion SR; 150mg OD x 3d, then 150mg BID x 7-12w
- good option if Hx depression or concern re: weight gain