Spirometry
- Diagnosis asthma
- Diagnosis COPD + severity
- restrictive pattern
- Obstructive pattern
- Asthma
FEV1 bronchodilator change > 10% adults, >12% kids - COPD
FEV1/FVC < 70%
FEV 60-80 mild, 40-59 moderate, <40 severe
- Restrictive
FEV1/FVC normal (>70%)
FVC reduced - Obstructive
FEV1/FVC reduced (<70%)
FVC normal
FEV1 reduced based on severity
Asthma - Adults (> 11)
Indications of poor control
Some risks for exacerbation
Daytime symptoms > 2 week
Reliever use > 2 week
Any night or waking symptoms
Limitation activity
High salbutamol use > 3 cans year
High eosinophil count
Smoke/vape
Asthma - Adults (> 11)
Levels of management
- AIR PRN
ICS + LABA - budeonoside + fometorol
1-2 puffs ~12 one occasion, max 24 puffs/24 hr
Review if >12 puffs day - MART - Low dose
- MART - Medium dose
- Blood eosinophils + refer
Oral steroid use in Asthma in adults
Start within 1 hour presentation if
- Worsening symptoms over the day
- Not resolving quickly with reliever
- Needing salbutamol within 4 hours
37.5-50mg day 5-10 days
adolescence 1mg/kg 3 days
Asthma kids 6 - 11
Indications for trial ICS
Daytime symptoms >1 week
Night/waking > 2 month
Symptoms restrict activity / limitation
Exacerbations > 3 monthly
Severe asthma
Asthma kids 6 - 11
Levels of treatment
- Salbutamol PRN
- Low dose ICS +
(fluticasone or cicloneside) - Medium dose ICS or low dose ICS + LABA (fometerol)
- Medium dose ICS + LABA
- Referral
Asthma kids 6 - 11
Oral steroids
Consider in exacerbation if
- Not improving over day
- Reliever within 4 hours
1mg/kg 3 days
Asthma Kids 1-5
Oral steroids
Not indicated
Asthma Kids 1-5
Indications for trial ICS
Daytime symptoms > 2 week
Night time symptoms >2 month
Restricting activity/sleep
>4 acute wheezy episodes per year
> 1 ED
Acute Asthma Management
> 6 yo
Salbutamol 4- 12 puffs every 20-30mins
OCS if > mild
< 6yo
Salbutamol 2-6 puffs initially
THen 4-12 puffs every 20-30 mins
No OCS
COPD Medications examples
- LAMA
- LABA
- SAMA
- ICS
- Tiotropium
- Indacterol
- Ipratropium
- Fluticasone or budenoside
COPD Medication mangement levels
- Salbutamol PRN
- Monotherapy LAMA
(2 = LABA) - Combined LAMA/LABA
- Add ICS
Add ICS if severe exacerbation or 2 moderate in past year
*Increased risk pneumonia
COPD Exacerbation management
Salbutamol 8 puffs once
Not responding add OCS
30-50mg 5 days
If infective
-Amoxil 500mg TDS 5 days
OR
- doxy 100mg BD 5 days
