Asthma

Question 1

What is asthma?

Answer 1

A reversible, obstructive, chronic inflammatory disease of the airways with increased bronchial sensitivity to various stimuli and bronchoconstriction in consequence.

Question 2

What are the risk factors for asthma?

Answer 2

Low-birth-weight family history, bottle-fed, atopy, pollution, parental smoking.

Question 3

What is this a presentation of?

Wheeze on prolonged expiration, shortness of breath, chest tightness cough.

Answer 3

Asthma

Question 4

What are the triggers for asthma?

Answer 4

1. Pollen, house dust mite, feathers , fur
2. Exercise, cold air
3. URTI, LRTI
4. Chemicals, smoke, traffic

Question 5

How is asthma diagnosed?

Answer 5

1. Based on clinical information for a symptom diary
2. PEFR shows diurnal variation and increases after salbutamol use
3. Trial salbutamol

Question 6

What is the non-pharmaceutical management for asthma?

Answer 6

1. Annual review of symptoms, exacerbations, time off school.
2. Check symptoms with exercise and nocturnal waking full stop
3. Check inhaler technique
4. Review exacerbation action plan
5. Record height and weight on centile chart

Question 7

What is the pharmaceutical management for asthma?

Answer 7

1. Salbutamol 100mcg with spacer, if needed >3x per week, then step 2.
2. Add beclomethasone (Clenil 50-200mcg/12hr)
3. Evening dose LTRA (Montelukast 4mg) if <5yrs, and LABA (salmeterol 50mcg/12hrs) if >5yrs.
4. Refer to specialist, increased inhaler steroid dose
5. Oral steroids

Question 8

What is the acute management of an asthma attack?

Answer 8

1. Sit up, high flow 100% oxygen
2. Salbutamol and ipratropium bromide nebuliser every 20 mins for the 1st hour
3. IV hydrocortisone or PO prednisolone
4. One IV dose magnesium sulphate
5. Consider IV aminophylline/IV salbutamol

Question 9

What is considered a moderate acute asthma attack?

Answer 9

1. PEFR 50-75%

2. Sats >92%

Question 10

What is considered a severe acute asthma attack in 2-5 year olds?

Answer 10

1. PEFR 33-50%
2. Can’t complete sentences
3. Use of accessory muscles
4. PaCO2 low
5. RR >40, HR >140

Question 11

What is considered a severe acute asthma attack in 5-12 year olds?

Answer 11

1. PEFR 33-50%
2. Can’t complete sentences
3. Use of accessory muscles
4. PaCO2 low
5. RR >30, HR >125

Question 12

What is considered a severe acute asthma attack in >12 year olds?

Answer 12

1. PEFR 33-50%
2. Can’t complete sentences
3. Use of accessory muscles
4. PaCO2 low
5. RR >25, HR >110

Question 13

What is considered a life-threatening acute asthma attack?

Answer 13

1. PEFR <33%
2. Sats <92%
3. Silent chest, cyanosis, bradycardia, hypotension, exhaustion, coma, poor respiratory effort.
4. PaCO2 normal, PaO2 <8

Question 14

What is considered to be a near fatal acute asthma attack?

Answer 14

1. Respiratory acidosis

2. PaCO2 high

Question 15

What is required for the discharge of a patient with an acute asthma attack?

Answer 15

1. PEFR >75%, sats >95%
2. Good inhaler technique
3. Salbutamol MDI every 4hrs - weaning step down plan
4. Inhaled and oral prednisolone for 1 week
5. GP in one week, clinic follow up in one month.

Question 16

What should you ask about inhalers in an OSCE asthma station?

Answer 16

What inhaler? How many puffs? How often do you use it? Do you use a spacer? Do you always use it? Show me how you use it?

Question 17

What is the correct inhaler technique for those <4 years old?

Answer 17

1. Spacer with a mask.
2. Shake, attach, take 5 slow normal breaths through spacer.
3. Then press and continue to take deep breaths.

Question 18

What should you ask about in an asthma history?

Answer 18

1. Wake up feeling wheezy? Stops you exercising?
2. Triggers?
3. Other colour inhalers?
4. Asthma action plan? Hospitalised because of asthma?