Test Flashcards
What does the guideline aim to improve regarding asthma?
The accuracy of diagnosis, control of asthma, and reduction of asthma attacks
The guideline focuses on improving overall management of asthma for patients and healthcare providers.
Who is the guideline intended for?
GPs, practice nurses, healthcare professionals in asthma services, commissioners, providers, and patients with asthma
This includes their families and carers.
What should be included in the initial clinical assessment of suspected asthma?
A structured clinical history
Symptoms alone should not be used without objective testing.
True or False: A history of atopic disorders alone can be used to diagnose asthma.
False
Objective testing is required for diagnosis.
What are some objective tests for diagnosing asthma?
- FeNO
- Spirometry
- Bronchodilator reversibility testing
- Peak flow variability
These tests help to confirm the presence of asthma.
What spirometry result indicates a diagnosis of asthma?
FEV1/FVC ratio less than 70% or below the lower limit of normal
This is a key diagnostic criterion.
What constitutes a positive bronchodilator reversibility test?
Improvement in FEV1 of 12% or more and an increase in volume of 200 ml or more
This indicates a significant response to bronchodilator therapy.
What is the first-line pharmacological treatment for symptom relief in asthma?
Short-acting beta2 agonist (SABA)
SABAs are typically used for quick relief of asthma symptoms.
What is the role of inhaled corticosteroids (ICS) in asthma management?
Maintenance therapy with dose adjustments based on asthma control
ICS are essential for long-term control of asthma.
Fill in the blank: A _______ is used for asthma that is uncontrolled with low-dose ICS.
leukotriene receptor antagonist (LTRA)
LTRAs are added to help manage asthma symptoms when ICS alone is insufficient.
True or False: The recommendations in the guideline are mandatory for all healthcare professionals.
False
What should be included in the initial clinical assessment for suspected asthma?
- Structured clinical history
- Physical examination
- Objective tests if available
Fill in the blank: Asthma should not be diagnosed based solely on __________.
symptoms alone
What are two objective tests recommended for diagnosing asthma?
- Fractional exhaled nitric oxide (FeNO)
- Spirometry
What does a FeNO level of 40 parts per billion (ppb) or more indicate?
A positive test for asthma in adults.
What is the significance of a forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) ratio of less than 70%?
It is regarded as a positive test for obstructive airway disease.
What should be done for children under 5 with suspected asthma?
Treat symptoms based on observation and clinical judgement, and review regularly.
What is the role of skin prick tests in asthma diagnosis?
To identify triggers after a formal diagnosis of asthma has been made.
True or False: Occupational asthma should be checked for in all adults with suspected asthma.
True
What is the recommended approach for children unable to perform objective tests at age 5?
- Continue treatment based on observation
- Retry tests every 6 to 12 months
- Consider referral for specialist assessment
What is the recommended action if spirometry and FeNO tests cannot be performed immediately for acutely unwell patients?
Perform tests when acute symptoms have been controlled.
What does a positive bronchodilator reversibility (BDR) test indicate?
An improvement in FEV1 of 12% or more, along with an increase in volume of 200 ml or more.
Fill in the blank: Local commissioners and providers have a responsibility to promote an __________ health and care system.
environmentally sustainable
What should be done if there is diagnostic uncertainty after an initial assessment?
- Monitor peak flow variability for 2 to 4 weeks
- Consider additional objective tests
What is a key consideration regarding a person’s smoking status in relation to FeNO levels?
Smoking status can lower FeNO levels both acutely and cumulatively.
What is the purpose of the NICE guideline regarding asthma management?
To provide evidence-based recommendations for the diagnosis, monitoring, and management of asthma.
What does a PC20 value of 8 mg/ml or less indicate in a direct bronchial challenge test?
A positive test for airway hyperreactivity.
What is the recommended action if there is diagnostic uncertainty after normal spirometry in adults aged 17 and over?
Offer a direct bronchial challenge test with histamine or methacholine
If FeNO level is 40 ppb or more with no variability in peak flow readings, or if FeNO level is 39 ppb or less with variability in peak flow readings.
What FeNO level and peak flow variability indicate a direct bronchial challenge test should be considered in adults?
FeNO level between 25 ppb and 39 ppb with no variability in peak flow readings
Obstructive spirometry without bronchodilator reversibility is also required.
What is regarded as a positive result in a direct bronchial challenge test?
PC20 value of 8 mg/ml or less
This indicates bronchial hyperreactivity.
What criteria should be met to diagnose asthma in children and young people aged 5 to 16?
Symptoms suggestive of asthma and:
* FeNO level of 35 ppb or more with positive peak flow variability
* Obstructive spirometry with positive bronchodilator reversibility
Diagnosis should consider clinical symptoms and objective test results.
When should asthma be suspected in children and young people aged 5 to 16?
If they have symptoms suggestive of asthma and:
* FeNO level of 35 ppb or more with normal spirometry and negative peak flow variability
* Normal spirometry, a FeNO level of 34 ppb or less, and positive peak flow variability
Other combinations of FeNO and spirometry results can also indicate suspicion.
What should be done if symptom control remains poor after asthma treatment in children and young people?
Review the diagnosis after 6 weeks by repeating abnormal tests and reviewing symptoms
Consider referring for specialist assessment if necessary.
What is the positive test threshold for FeNO in adults?
40 ppb or more
This indicates a higher likelihood of asthma.
What indicates a positive bronchodilator reversibility test in adults?
Improvement in FEV1 of 12% or more and increase in volume of 200 ml or more
This shows responsiveness to bronchodilators.
What is the guideline for diagnosing asthma in adults with obstructive spirometry?
Symptoms suggestive of asthma and:
* FeNO level of 40 ppb or more with positive bronchodilator reversibility
* FeNO level between 25 ppb and 39 ppb with positive bronchial challenge test
* Positive bronchodilator reversibility and positive peak flow variability irrespective of FeNO level
These criteria help confirm asthma diagnosis.
What should be considered if an adult with suspected asthma has a FeNO level below 40 ppb and normal spirometry?
Consider alternative diagnoses or referral for a second opinion
This is necessary if other test results do not align with asthma diagnosis.
What is the recommended first-line maintenance therapy for adults with asthma?
Offer a low dose of an inhaled corticosteroid (ICS)
This is for those with symptoms indicating the need for maintenance therapy.
What is the guideline for adjusting asthma medication in adults if asthma is uncontrolled on a low dose of ICS?
Offer a leukotriene receptor antagonist (LTRA) in addition to the ICS
Review the response to treatment in 4 to 8 weeks.
In children and young people with asthma, what is the guideline for using short-acting beta2 agonist (SABA) as reliever therapy?
Offer a SABA for those with newly diagnosed asthma
This is appropriate for infrequent, short-lived wheeze and normal lung function.
What should be done if asthma is uncontrolled in children and young people on a low dose of ICS?
Offer a long-acting beta2 agonist (LABA) in combination with the ICS
Review LTRA treatment based on the degree of response.
What does off-label use mean in the context of asthma medications?
Use of medicines not authorized for a specific age group or condition
For example, LTRAs and LABAs may not have UK marketing authorization for children under 18.
What is the recommended reliever therapy for children aged 5 to 16 with newly diagnosed asthma?
Offer a SABA
SABA stands for short-acting beta-agonist.
When should a paediatric low dose of ICS be offered as maintenance therapy?
For children with symptoms indicating the need for maintenance therapy or uncontrolled asthma with SABA alone
Symptoms include asthma-related symptoms 3 times a week or more.
What should be considered if asthma is uncontrolled in children on a low dose of ICS?
Consider adding an LTRA
LTRA stands for leukotriene receptor antagonist.
What does MART stand for in asthma management?
Maintenance and reliever therapy
MART involves using a combined inhaler for both maintenance and relief.
What is the recommendation for children under 5 with suspected asthma?
Offer a SABA as reliever therapy
This should be used alongside all maintenance therapy.
What is the purpose of an asthma self-management program?
To provide a written personalized action plan and education
It includes strategies to minimize exposure to air pollution.
What should be monitored when decreasing maintenance therapy?
The effects of decreasing therapy should be monitored and reviewed
This includes self-monitoring and follow-up with a healthcare professional.
What is risk stratification in asthma management?
Categorizing individuals by their likelihood of poor outcomes
Factors include non-adherence and psychosocial problems.
What should be done if asthma control is suboptimal during a review?
Confirm adherence, review inhaler technique, and consider treatment changes
Use validated questionnaires to aid monitoring.
What defines a low dose of ICS for adults?
Less than or equal to 400 micrograms budesonide or equivalent
This classification helps in determining treatment strategies.
What is the maximum licensed daily dose when increasing ICS treatment?
Do not exceed the maximum licensed daily dose
Consider quadrupling the regular ICS dose for adults when control deteriorates.
True or False: Challenge testing is recommended to monitor asthma control.
False
Challenge testing should not be used for monitoring asthma control.
What is expiratory polyphonic wheeze?
A whistling sound with multiple pitches during exhalation
It indicates narrowing or obstruction in the airways.
Fill in the blank: ICS doses vary across different formulations and should be the _______ that provides optimal control.
smallest doses
This approach helps to minimize side effects.
What should be included in a child’s asthma action plan?
Information on contacting a healthcare professional if asthma control deteriorates
This is crucial for timely intervention.
What is risk stratification in the context of asthma?
A process of categorising a population by their relative likelihood of experiencing negative clinical outcomes related to asthma.
What factors can guide risk stratification for asthma patients?
- Non-adherence to asthma medicines
- Psychosocial problems
- Repeated episodes of unscheduled care
What does suspected asthma refer to?
A potential diagnosis of asthma based on symptoms and response to treatment that has not yet been confirmed.
How is uncontrolled asthma defined?
Asthma that impacts a person’s lifestyle or restricts normal activities, with symptoms like coughing and wheezing.
What are the pragmatic thresholds to define uncontrolled asthma?
- 3 or more days a week with symptoms
- 3 or more days a week with required use of a SABA for relief
- 1 or more nights a week with awakening due to asthma
What objective tests does NICE recommend for suspected asthma?
- Spirometry
- Fractional exhaled nitric oxide (FeNO) testing
What are the key recommendations for research on asthma diagnosis and management?
- Assessing diagnostic accuracy of objective tests in children and young people
- Evaluating cost-effectiveness of indirect bronchial challenge tests in adults
- Monitoring adherence using electronic alert systems
- Optimal frequency of checking inhaler technique
- Long-term effectiveness of tele-healthcare for asthma control
What is the impact of asthma on quality of life?
Uncontrolled asthma can significantly decrease a person’s quality of life and may lead to medical emergencies.
True or False: There is a gold standard test available to diagnose asthma.
False
What methods are available to assess the likelihood of asthma?
- Spirometry
- Peak flow measurements
- Bronchodilator reversibility tests
- Fractional exhaled nitric oxide (FeNO) measurements
Fill in the blank: Asthma is characterized by attacks of _______ and wheezing.
breathlessness
What is the estimated number of people affected by asthma worldwide according to the 2018 Global Asthma report?
339 million people
What is a significant finding regarding asthma diagnosis in adults?
Up to 30% of adults diagnosed with asthma do not have clear evidence of the condition.
What is the aim of NICE’s cost impact assessment related to asthma diagnosis recommendations?
To project a saving of approximately £12 million per year in England, before implementation costs.
What is the role of a personalised action plan in asthma management?
To guide children and young people in managing worsening asthma and reassure them about their treatment.
What are the recommendations regarding increasing the dose of inhaled corticosteroids (ICS) in children and young people?
The committee agreed that increasing ICS doses within licensed limits should not adversely affect child growth.
What is the significance of reviewing self-management plans for children and young people with asthma?
To ensure appropriate support and management when asthma control is deteriorating.
What is one of the primary causes of underdiagnosed asthma?
Misdiagnosis or lack of clear evidence in some individuals.
What are the potential clinical outcomes of effective asthma management?
Improved quality of life, reduced healthcare service use, and lower associated costs.
What type of therapy is commonly used for asthma management?
Inhaled corticosteroids (ICS)
What are some environmental risk factors associated with asthma?
- Inhalation of allergens
- Chemical irritants
What is the importance of objective testing for asthma diagnosis?
To provide accurate diagnosis and improve patient outcomes.
What is the significance of monitoring asthma control?
To assess treatment effectiveness and make necessary adjustments.
Fill in the blank: Asthma can be described as a _______ _______ respiratory disease.
chronic
What is the main challenge in accurately diagnosing asthma?
Debate over which test or combination of tests is most effective
Tests include histamine/methacholine or mannitol challenge tests.
What is the impact of suboptimal asthma control?
Decreased quality of life, increased healthcare service use, and associated costs.
How can asthma control be monitored?
By measuring airway obstruction, inflammation, and using validated questionnaires.
What varies among individuals with asthma?
Severity of asthma and its impact on normal activities.
What is a crucial part of asthma management when symptoms are well controlled?
Decreasing treatment.
What is the primary focus of asthma management?
Reducing exposure to triggers, relieving symptoms, and reducing airway inflammation.
What does adherence to regular asthma treatment reduce?
Risk of significant asthma attacks.
What is the aim of the guideline regarding asthma?
To provide clear advice for diagnosing and managing asthma.
Which age groups does the asthma guideline cover?
Children under 5, 5 to 16, and adults aged 17 and over.
What does the section on managing chronic asthma focus on?
Personalized action plans and pharmacological management.
What type of asthma management is not covered by the guideline?
Severe, difficult-to-control asthma and management of acute asthma attacks.
What new evidence was identified regarding asthma management in children and young people?
Increasing the dose of inhaled corticosteroids within a self-management programme.
What recommendations were made in March 2021 regarding asthma management?
Include minimizing indoor air pollution and reducing outdoor air pollution exposure in personalized action plans.
Fill in the blank: The focus of asthma management has shifted towards _______.
[personalised treatment plans].
True or False: The guideline is intended for re-diagnosing people who already have an asthma diagnosis.
False.
What tools and resources has NICE produced to assist with asthma management?
Guidance on putting NICE guidelines into practice.
What was clarified in February 2020 regarding self-management in children and young people with asthma?
New recommendations were made on self-management.
What was updated in the recommendations regarding air pollution?
Links to guidelines on indoor and outdoor air quality were added.
