Asthma

Question 1

What is the first line therapy for newly diagnosed asthma in over 12s?

Answer 1

Air therapy: Combination Low dose inhaled corticosteroid (anti-inflammation)
Formoterol
-> immediate symptom relief

Should be PRN as needed

Question 2

What is second line therapy for new asthma diagnosis?

Answer 2

MART inhaler with MODERATE inhaled corticosteroid and LABA like formoterol

Question 3

What is third line therapy for asthma?

Answer 3

MART inhaler with MODERATE inhaled corticosteroid with LABA like formoterol for

Question 4

What should be done 4th line if asthma is still not controlled?

Answer 4

Check FeNO and blood eosinophil count and if raised, refers o specialist asthma service

Question 5

What to do 4th line if FeNO or blood eosinophil are not raised?

Answer 5

Moderate-dose MART with Addition of leukotriene receptor antagonist like montelukuast tablet every night
Long acting muscarinic agonist like tiotropium

Question 7

What are the signs of poorly controlled asthma?

Answer 7

signs include:
Tachypnoea
Increased work of breathing
Hyperinflated chest
Expiratory polyphonic wheeze throughout the lung fields
Decreased air entry (if severe)

Question 8

What are triggers for asthma exacerbation?

Answer 8

Cold air and exercise
Pollution and cigarette smoke
Allergens such as animal dander, dust mites and pollen
Irritants such as perfumes, paints or air fresheners
Medications such as NSAIDs or beta-blockers

Question 9

Which test is sufficient enough to confirm asthma?

Answer 9

Clinical history with blood eosinophil level OR FeNO level

Question 10

Which test should be done if FeNO and blood eosinophil are inconclusive?

Answer 10

Bronchial challenge

Question 11

What is considered uncontrolled asthma?

Answer 11

Patient has an exacerbation requiring oral corticosteroids, so move to next INR of management

Question 13

What is the criteria for discharge after asthma attack?

Answer 13

Stable on regular salbutamol inhaler for 24 hours
PEFR above 75%

Question 14

What is the PEFR value for discharge?

Answer 14

75%

Question 15

When are oral corticosteroids used in asthma?

Answer 15

Acute severe exacerbation
Maintenance therapy in very poorly controlled asthma unresponsive to add-on therapies

Question 16

What is the next step for asthma not controlled by moderate dose MART?

Answer 16

Moderate dose MART includes LABA and moderate dose ICS.

Addition of LAMA should be done.

Question 17

What is the best test for asthma when FeNO levels or eosinophil count are insufficient?

Answer 17

Bronchodilator reversibility testing which is an objective test recommended by NICE, if patient symptoms are not in severe exacerbationn

Question 18

What is the first line therapy for patients with severe exacerbation of asthma at diagnosis?

Answer 18

Begin with MART rather than AIR because this indicates uncontrolled asthma

Question 19

What is the difference between AIR and MART?

Answer 19

AIR is as needed either LABA or ICS

MART is combination LABA and ICS

Question 21

What are the hisotlogical findings in asthma?

Answer 21

Curschmann spirals, where shed epithelium becomes whorled mucous plugs

Question 22

What PEFR indicates acute severe asthma?

Answer 22

PEFR 33-50%

Question 23

What PEFR value indicates life threatening asthma?

Answer 23

Less than 33% PEFR

Question 24

What is a CO2 indicator for life threatening asthma? n

Answer 24

Normal CO2 as the patient tires from hyperventilation to become normocapnci

Question 25

What is the criteria for life threatening asthma?

Answer 25

Oxygen sat less than 92% Normal CO2 PEFR less than 33% Silent chest Confusion Cardiac arrythmia Hypotension

Question 26

What is the criteria for acute severe asthma?

Answer 26

33-50% PEFR Respiratory rate over 25 Inability to complete full sentences Use of accessory muscles Tachypnoea Expiratory wheeze throughout lungs

Question 27

What are the features of moderate asthma?

Answer 27

PEFR over 50%

Question 28

What are the principles of peak flow use?

Answer 28

The patient should record the highest reading (as long as the readings are all fairly close) Perform standing up Exhale quickly with high force

Question 29

What must be taken for asthma?

Answer 29

LABA

Question 30

When to refer for respiratory specialist in asthma?

Answer 30

For treatment regime contains a high dose ICS

Question 31

What is the most commmonc abuse of occupational asthma?

Answer 31

Isocyanates from spread painting and foam moulding with adhesives

Question 32

How to taper steroid dose in asthma?

Answer 32

Reduce by 25-50%

Question 33

What to do with asthma treatment in long term?

Answer 33

Consider stepping down treatment every 3 months

Question 34

How can asthma be diagnosed in children aged 5-16?

Answer 34

PEF variability is 20% or higher FeNO over 35 PPV FEV1 increases by 12% or more after giving bronchodilator

Question 35

How does asthma exacerbation present on spirometry?

Answer 35

FVC is preserved FEV1 will be severely be reduced ed

Question 36

What is given for mild asthma exacerbation?

Answer 36

Salbutamol nebulised with prednisolone

Question 37

What is the long termamangement for asthma after exacerbation?

Answer 37

40-50mg prednisolone for up to 5 days following asthma attack

Question 38

What are general features of life threatening asthma?

Answer 38

Cyanosis Altered conscious level Exhaustion Hypotension

Question 39

What drug must be given to in acute asthma attack?

Answer 39

Steroids, either oral prednisolone 40-50mg or 100mg IV hydrocortisone

Question 40

How long to continue steroids in asthma attacks?

Answer 40

Five days minimum until recovery

Question 41

What determines treatment pathway with frequent asthma exacerbations uncontrolled on moderate dose MART?

Answer 41

Inflammatory markers

Question 42

What is next step if patient has normal inflammatory markers and uncontrolled asthma on MART?

Answer 42

Add leukotriene antagonist or LAMA

Question 43

What is next step if patient has raised inflammatory markers and uncontrolled asthma on MART?

Answer 43

Refer to spieclaist

Question 44

What is the NICE guidance for hospital admission in asthma?

Answer 44

Admit people with a moderate asthma exacerbation with worsening symptoms despite initial bronchodilator treatment and/or who have had a previous near-fatal asthma attack.

Question 45

What is used for step down treatment for asthma?

Answer 45

aim for a reduction of 25-50% in the dose of inhaled corticosteroids

Question 46

What is the first line investigation for asthma?

Answer 46

Eosinophil or FENO

Question 47

What is the order of asthma investigations?

Answer 47

First line= eosinophil count and FeNO Second line= spirometry 3rd line= peak expiratory flow

Question 48

What is reccomended for step-down in asthma?

Answer 48

NICE guidelines recommend considering treatment step-down after at least 3 months of sustained good control

Question 49

What is the management of respiratory failure in asthma?

Answer 49

Mechanical ventilation

Question 50

How does aminophyllije work?

Answer 50

It is a combination drug with Theophylline and Ethylenediamine. . Side effects include headache, nausea, palpitations and seizures

Question 51

What is the order of asthma amangement escalation?

Answer 51

Oh Shit I Hate My asthma 1.Oxygen 2. Salbutamol nebulisers 3. Ipratropium bromide nebulisers 4. Hydrocortisone IV OR Oral Prednisolone 5. Magnesium Sulfate IV 6. Aminophylline/ IV salbutamol

Question 52

What is first to give in severe asthma?

Answer 52

Oxygen

Question 53

What is second to give in severe asthma?

Answer 53

Salbutamol nebuliser

Question 54

What is third to give in severe asthma?

Answer 54

Ipatropium bromide nebuliser

Question 55

What is fourth to give in severe asthma?

Answer 55

IV hydrocortisone or oral prednisolone

Question 56

What is fifth to give in severe asthma?

Answer 56

Magnesium sulphate IV

Question 57

What is sixth and final asthma severe amangement?

Answer 57

Aminophylline/ IV salbutamol

Question 58

How to do step down treatment of asthma?

Answer 58

step-down of inhaled corticosteroids (ICS) by 25–50% every step-down

Question 59

What indicates hospital admission for asthma e even with Clincial improvement and stability?

Answer 59

Pregnancy Intiially presented with features requiring emergency treatment

Question 60

What to do for stabilisation after acute treatment!

Answer 60

continued oral prednisolone and ongoing monitoring in hospital

Question 61

What is the most common cause of occupational astham?

Answer 61

Isocyanates from spray painting and foam moulding

Question 62

Low BP, low oxygen, metabolic acidosis with resp compensation to

Question 63

What FeNO level confirms asthma in adults?

Answer 63

50

Question 64

Which eosinophil count confirms asthma?

Answer 64

0.6 or above

Question 65

What improvement is diagnostic of asthma?

Answer 65

Increase in FEV1 by 12%

Question 66

What investigations if patient symptoms aren’t controlled on moderate MART?

Answer 66

FeNO or blood eosinophil count

Question 67

What to do if FeNo and eosinophil are normal but moderate dose MART is not improving symptoms?

Answer 67

add LTRA or LAMA

Question 68

What to do if moderate dose mart and LTRA and LAMA does not control symptoms?

Answer 68

refer people to a specialist in asthma care

Question 69

Which value alone confirms asthma?

Answer 69

FeNO above 50

Question 70

What will CXR be for asthma?

Answer 70

Hyperinflation

Question 71

What medications should always be paired and initiated early in acute asthma management?

Answer 71

Systemic oral corticosteroids should be used in conjunction with nebulised short acting bronchodilators

Question 72

What causes Bronchieactasis and eosinophilia?

Answer 72

Aspergillosis, which should be managed with oral prednisolone