Asthma

Question 1

What features of symptoms increase the likelihood of asthma?

Answer 1

• Symptoms vary over time and intensity
• Worse at night or early morning
• Triggered by exercise, allergens, cold air, or viral infections
• Improve with bronchodilators

These features help differentiate asthma from other respiratory conditions.

Question 2

What spirometry finding confirms asthma?

Answer 2

Reversible airflow obstruction

Specifically, an increase in FEV₁ ≥12% AND ≥200 mL after bronchodilator.

Question 3

What peak flow variability supports asthma diagnosis?

Answer 3

> 10% daily variability in adults

This variability indicates instability in airflow and is a characteristic of asthma.

Question 4

What is the preferred reliever therapy according to current GINA guidelines?

Answer 4

Low-dose ICS–formoterol (as-needed)

This approach is recommended for better asthma control.

Question 5

What medication combination is preferred for as-needed therapy in mild asthma?

Answer 5

Low-dose ICS + formoterol

This combination provides both control and relief.

Question 6

What are common asthma triggers?

Answer 6

• Viral respiratory infections
• Exercise
• Allergens (dust mites, pollen, animals)
• Cold air
• Smoke
• Air pollution

Identifying and avoiding these triggers is crucial for asthma management.

Question 7

What are common risk factors for asthma exacerbations?

Answer 7

• Overuse of SABA (>3 canisters/year)
• Poor adherence to ICS
• Previous severe exacerbation or ICU admission
• Smoking

These factors can increase the likelihood of asthma attacks.

Question 8

What are signs of a severe asthma exacerbation?

Answer 8

• Unable to speak full sentences
• RR ≥30
• HR ≥120
• PEF <50% predicted
• Accessory muscle use

Recognizing these signs is critical for timely intervention.

Question 9

What initial medications are used for acute asthma exacerbation?

Answer 9

• Short-acting beta agonist (salbutamol)
• Systemic corticosteroids
• Oxygen if hypoxic

These medications help stabilize the patient during an exacerbation.

Question 10

What is the typical duration of oral steroids for an asthma exacerbation?

Answer 10

5–7 days

This duration is generally sufficient for managing exacerbations.

Question 11

What is SMART therapy in asthma management?

Answer 11

Single Maintenance And Reliever Therapy

Uses ICS-formoterol for both daily controller and reliever.

Question 12

What are the steps of asthma pharmacologic management according to GINA in ADULTS?

Answer 12

• Step 1: As-needed low-dose ICS-formoterol
• Step 2: Daily low-dose ICS or as-needed ICS-formoterol
• Step 3: Low-dose ICS-LABA
• Step 4: Medium-dose ICS-LABA
• Step 5: Add-on biologics or specialist referral

These steps guide the treatment approach based on severity.

Question 13

What biologic therapies may be used in severe asthma?

Answer 13

• Omalizumab (anti-IgE)
• Mepolizumab (anti-IL-5)
• Benralizumab (anti-IL-5 receptor)

These therapies target specific pathways involved in asthma.

Question 14

What are non-pharmacologic management strategies for asthma?

Answer 14

• Smoking cessation
• Allergen avoidance
• Vaccinations (influenza, pneumococcal if indicated)
• Asthma action plan

These strategies complement pharmacologic treatments.

Question 15

What should be assessed at every asthma visit?

Answer 15

• Symptom control
• Exacerbation history
• Inhaler technique
• Medication adherence

Regular assessments help optimize asthma management.

Question 16

What criteria define well-controlled asthma? (GINA control assessment)

Answer 16

• Symptoms ≤2 days/week
• No nighttime awakenings
• No activity limitation
• Reliever ≤2 uses/week

These criteria help evaluate the effectiveness of asthma management.

Question 17

What symptom pattern suggests asthma in children ≤5 years? (4)

Answer 17

• Recurrent wheezing episodes
• Cough or wheeze with exercise, laughing, or crying
• Night cough without infection
• Symptoms triggered by viral infections

These symptoms are indicative of asthma in young children.

Question 18

What factors increase the likelihood that recurrent wheeze represents asthma rather than viral bronchiolitis? (4)

Answer 18

• Personal history of eczema
• Parental history of asthma
• Wheeze occurring without viral infections
• Allergic sensitization

These factors help differentiate asthma from other respiratory conditions.

Question 19

What is the preferred reliever medication for asthma symptoms in pediatrics?

Answer 19

Short-acting beta agonist (SABA) – salbutamol

SABA is commonly used for quick relief of asthma symptoms.

Question 20

What is the preferred controller medication for persistent asthma in pediatrics?

Answer 20

Low-dose inhaled corticosteroid (ICS)

ICS helps manage chronic asthma symptoms.

Question 21

When should daily ICS therapy be started in children ≤5 years? (3)

Answer 21

• Symptoms ≥3 times per week
• Night awakenings due to asthma
• Frequent wheezing episodes requiring SABA

These criteria indicate the need for regular treatment.

Question 22

What is the preferred inhaler delivery method for young children?

Answer 22

MDI with spacer

This method ensures effective medication delivery.

Question 23

What additional device is required for children under ~5 years when using a spacer?

Answer 23

Face mask

A face mask helps ensure proper inhalation of medication.

Question 24

What medication can be considered as an alternative controller if ICS cannot be used?

Answer 24

Leukotriene receptor antagonist (montelukast)

This medication can help control asthma symptoms when ICS is not suitable.

Question 25

What are common **side effects** of inhaled corticosteroids in children? (3)

Answer 25

* Oral candidiasis * Dysphonia * Mild growth velocity reduction (small, usually temporary) ## Footnote Monitoring for side effects is important during treatment.

Question 26

What is the most common **trigger** of asthma exacerbations?

Answer 26

Viral respiratory infections ## Footnote These infections frequently lead to worsening asthma symptoms.

Question 27

What are signs of a **severe asthma exacerbation** in children? (5)

Answer 27

* Unable to speak or feed normally * Marked tachypnea * Chest retractions or accessory muscle use * Oxygen saturation <92% * Drowsiness or agitation ## Footnote Recognizing these signs is critical for timely intervention.

Question 28

What **monitoring** should be done in children receiving long-term ICS therapy? (3)

Answer 28

* Growth monitoring (height) * Asthma symptom control * Inhaler technique ## Footnote Regular monitoring helps ensure effective treatment and safety.

Question 29

When should **referral to a specialist** be considered? (4)

Answer 29

* Poor asthma control despite moderate-dose ICS * Frequent severe exacerbations * Uncertain diagnosis * Life-threatening asthma episode ## Footnote These situations warrant specialist evaluation for better management.

Question 30

What key **education** should be given to parents of children with asthma? (4)

Answer 30

* Correct inhaler technique * Recognition of exacerbation symptoms * Proper reliever use * Written asthma action plan ## Footnote Educating parents is crucial for effective asthma management.

Question 31

How can you diagnose asthma in a child 1- 5 y/o?

Answer 31

≥ 2 episodes of: 1 - Documented airflow obstruction (wheeze, cough, difficulty breathing) Preferably documented by the physician 2 - Documented reversibility of airflow obstruction Preferred: physician observes improvement w/ SABA +/- oral steroids Alternative: Convincing parent report of improved symptoms after a 3 mo trial of medium-dose of ICS

Question 32

How much should the FEV1 drop in a positive methacoline challenge test?

Answer 32

FEV1 < 20%

Question 33

Asthma is considered well-controlled in children if: (6)

Answer 33

Daytime sx: ≤ **2d/**w Night sx: ≤ **1x/**w Physical activity: Normal Exacerbation: mild, infrequent Absence from work/school: none FEV1 or PEF: ≥** 90%** of personal best PEF diurnal variation:** < 10 - 15%**

Question 34

Four non-pharmacological management strategies in asthma

Answer 34

Avoid triggers as much as possible (including NSAIDs) Encourage aerobic exercise Smoking cessation Annual influenza vaccination

Question 35

Step 1 of asthma treatment in childrne 6 - 11 y/o

Answer 35

Low-dose ICS taken **whenever SABA is taken**

Question 36

Step 2 of asthma treatment in childrne 6 - 11 y/o

Answer 36

Daily low-dose ICS only

Question 37

Step 3 of asthma treatment in childrne 6 - 11 y/o

Answer 37

* Low-dose ICS-LABA OR * Medium dose ICS

Question 38

Step 4 of asthma treatment in childrne 6 - 11 y/o

Answer 38

* Medium dose ICS-LABA

Question 39

What is the severity score for asthma exacerbation in children < 6 mo?

Answer 39

PRAM score (Pediatric Respiratory Assessment Measure)

Question 40

What are the components of the PRAM score?

Answer 40

**“S.O.A.T.S.”** S – Suprasternal retractions O – Oxygen saturation A – Air entry T – Tachypnea (respiratory rate) S – Scalene muscle contraction

Question 41

What is considered a severe asthma exacerbation in children?

Answer 41

PRAM score > 8 ( - Audible wheezing/silent chest - Absent air entry - SpO2 < 92%)

Question 42

What is the management for asthma exacerbations in children < 6 y/o based on the PRAM severity score?

Answer 42

**Mild**: Salbutamol + oral steroids **Moderate**: Oral steroids + salbutamol + ipratropium Consider admission **Severe**: Oral steroids + salbutamol + ipratropium Other supportive measures: IV, NPO, nebulized salbutamol, IV magnesium sulfate

Question 43

After ED discharge for asthma, name TWO key follow-up components.

Answer 43

- Provide an asthma action plan - review inhaler technique (other acceptable: address adherence barriers, review goals of care, daily PEF monitoring)

Question 44

What are the three zones of a standard asthma action plan? (3)

Answer 44

Green — Well controlled; continue controller meds Yellow — Worsening symptoms; increase reliever / step-up therapy Red — Severe symptoms; rescue meds and seek urgent care

Question 45

What key elements should be included in an asthma action plan? (5)

Answer 45

Daily controller medications with doses Reliever medication instructions Symptom or peak-flow thresholds for zones Steps for worsening symptoms When to seek urgent/emergency care

Question 46

According to GINA 2025, what is the preferred reliever medication for asthma in children ≤5 years and why? (2)

Answer 46

Short-acting β₂-agonist (SABA) (e.g., **salbutamol**) **Reason: **insufficient evidence supporting ICS–formoterol reliever therapy in preschool children