Asthma

Question 1

diagnosis of asthma <6

Answer 1

• use history and physical (wheezing, improvement with SABA / ICS)

Question 2

diagnosis of asthma >6

Answer 2

use objective measure

1st line: pre/post spirometry
- FEV/FVC <75% predicted AND FEV1 >12% improvement post bronchodilator

2nd line: peak expiratory flow, positive challenge test

Question 3

asthma control criteria

Answer 3

• daytime symptoms <4 days / week
• nightime symptoms <1 night / week
• <4 doses of SABA / week (incl during exercise)
• normal physical activity
• no absenteeism due to asthma
• mild or infrequent exacerbations
• FEV1 or PEF >90% of personal best

Question 4

non-pharm management of asthma

Answer 4

• written action plan
• avoid allergens (dust, pets, mold)
• avoid smoking
• vaccinations: flu yearly, pneumococcal

Question 5

pharm management of asthma

Answer 5

6-11 years old

1. SABA prn
2. ICS + SABA prn
3. increase ICS dose + SABA prn
4. ICS + LABA + SABA prn
5. add LTRA

> 12 years old

1. SABA prn
2. ICS + SABA prn
3. ICS + LABA + SABA prn
4. increase ICS dose + LABA + SABA prn

Question 6

adverse effects SABA

Answer 6

• headache
• tremor
• tachycardia / palpitations
• hypokalemia and hyperglycemia with high doses

Question 7

adverse effects ICS

Answer 7

• oral candidiasis
• dysphonia
• cough
• long-term use, or higher than recommended doses: bruising, adrenal suppression, decreased BMD, cataracts