Asthma + COPD

Question 1

Incidence of asthma and peak age

Answer 1

5-8%

Peak age 5

Question 2

Drug ladder in asthma management

Answer 2

1. SABA (if using 3 times a week or night symptoms –> step 2)
2. SABA + inhaled steroid (beclometasone 200-800ug/day)
3. Add in long acting B2 agonist
   (options: benefit but not full control –> increase steroid to 800
   no benefit - stop and increase steroid
   Poor control - trail leukotriene receptor antagonist (montelukast))
4. trial of beclometasone up to 2000ug/d, oral leukotriene antagonist, oral B2 agonist modified release, theophylline
5. Add regular oral pred, refer

Question 3

Asthma symptoms

Answer 3

Wheeze
Cough
Tight chest
Intermitted dyspnoea, SOB

Question 4

Asthmatic on SABA + inhaled steroid, what is next step

Answer 4

Add LABA (salmeterol 50ug BD)

Question 5

Asthma severity:
PEFR: 50-75% predicted
RR less than 25

Answer 5

Moderate acute asthma

Question 6

Features of life threatening asthma

Answer 6

Life threatening - 33 92 CHEST
Cyanosis 
Hypotension 
Exhaustion 
Silent chest 
Tachy/brady arrhythmia

Question 7

PEFR 33-50%
RR>25
HR>110
Unable to complete full sentences

Answer 7

Severe asthma attack

Question 8

Discharge asthmatic when

Answer 8

Off nebulised drugs and stable on regular asthma therapy for 24h
PEFR >75%

Question 9

Prevalence of COPD

Answer 9

10-20% of over 40s

Question 10

MRC dyspnoea score

Answer 10

1. dyspnoea only on vigorous exertion
2. SOB on hurrying/walking up stairs
3. Walks slow/stop for breath
4. Stops for breath after less than 100m

Question 11

COPD complications

Answer 11

Acute exacerbation 
Polycythaemia 
Pneumothorax 
Long carcinoma 
Cor pulmonale

Question 12

ECG and spirometry findings in COPD

Answer 12

ECG - p pulmonale (r atrial hypertrophy), RVH, RAD

Spirometry - FEV1

Question 13

Severity of COPD

Answer 13

Mild - FEV1 >80%
Mod - FEV1 50-79%
Severe - FEV1 30-49%
Very severe - FEV1

Question 14

Mx COPD

Answer 14

Stop smoking, pulmonary rehab, influenza + pneumococcal vaccine, mucolytics (carbocisteine)

Question 15

Medical manage

1. Breathless and/or exercise limitation
2. Exacerbation/persistent breathless
3. Persistent exacerbations/breathless

Answer 15

1. SABA and/or SAMA PRN, SABA PRN may continue at all stages
2. FEV1 =/more 50% - LABA or LAMA (stop SAMA)
   FEV1 less 50% - LABA + ICS combo or LAMA
3. LABA + ICS + LAMA, consider home nebs, theophylline mat be considered

Question 16

Indication for LTOT

Answer 16

Clinically stable non-smoker PaO2 less than 7.3

PaO2 7.3-8 + PHT/cor pulmonale/polycythaemia/nocturnal hypoxaemia