Asthma

Question 1

Mechanism of action for:

a) SABA/LABA. Electrolyte imbalance? CI?
b) ICS. Long term effects?
c) SAMA/LAMA
d) Theophylline - possible SEs
e) Magnesium sulphate

Answer 1

a) B2 agonist - bronchodilator; hypokalaemia;
b) Reduces inflammatory response; thrush, osteoporosis
c) Muscarinic M3 receptors (inhibit bronchoconstriction)
d) ; in overdose - vomiting, seizures, arrhythmias,
e)

Question 2

RCP 3 questions for assessing current symptom severity in chronic asthma (mnemonic: SAD or NAD)

What other questions assess very high risk asthma patients?

Answer 2

Sleep/Nocturnal - In the last month/week have you had difficulty sleeping due to asthma (e.g. cough)
Activities - Has it interfered with activities of daily living?
Day - Have you had your usual asthma symptoms during the day?

Ever admitted for asthma treatment/ ever admitted to ITU?

Question 3

Asthma drug management (children)

a) < 5 years
b) 5 - 12 years

Answer 3

a) SABA&raquo_space; SABA + ICS/LTRA&raquo_space; SABA + ICS + LTRA&raquo_space; specialist referral
b) Similar to adults: SABA&raquo_space; SABA + ICS&raquo_space; SABA + ICS + LABA&raquo_space; SABA + ICS + LABA + LAMA/LTRA

Question 4

Asthma action plan.

a) 3 benefits
b) 2 self-administered medications for acute exacerbations
c) Moderate exacerbation - symptoms/peak flow
d) Severe exacerbation - symptoms/peak flow
e) 5 things on an asthma action plan

Answer 4

a) Recognition of worsening symptoms, allow self-management, identify need for treatment initiation, identify need for referral
b) Salbutamol (4-6 puffs via spacer every 10-20 minutes); oral prednisolone for 5 days and contact nurse/GP
c) Need salbutamol every 3-4 hours; PEFR 50-75% personal best; constant symptoms; difficulty with normal activity
d) Lack of response to salbutamol, significant SOB that interferes with talking/walking, rapid worsening, frightened, PEFR < 50% personal best
e) Personal best PEFR, triggers, acute management plan, drugs taking, allergies, Dr/Asthma nurse contact

Question 5

Acute asthma (paediatrics)

a) < 2y - SpO2 cutoff for severe? Signs
b) > 2y - SpO2 cutoff for severe? Signs

Answer 5

a) 92%; feeding, respiratory distress, cyanosis

b) 92%; HR/RR, PEFR, cyanosis, respiratory distress, agitation, coma, silent chest, poor respiratory effort

Question 6

Factors making asthma more likely than viral-induced wheeze (DR BANT)

Answer 6

Dry cough (acoryzal)
Recurrent/persistent (>4 weeks)
Bronchodilator response
Atopy (eczema, allergies, urticaria)
Nocturnal cough
Triggers (cold, laughter, pets, exercise)