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Summary

Discover expert asthma management guidance with the 'Asthma SBAQs' learning session presented by Ivy Ng. The session presents practical real-world scenarios, probing the most appropriate preliminary treatment for patients with asthma that varies in severity. The course will guide you on how to effectively manage and treat exacerbations, by providing an in-depth study of different medications and determining when it's best to use each. Additionally, you'll also be tested on crucial diagnostic skills such as interpreting spirometry results. This session offers a comprehensive exploration of asthma management that would refine and improve your current practice and patient outcomes. From inhaler technique checks to emergency treatments during acute episodes, this course covers it all. An unmissable professional development opportunity for any medical professional who wishes to hone their expertise in treating asthma.

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Learning objectives

Learning objectives:

  1. To learn about the steps involved in the diagnosis and treatment of asthma, from initial presentation to detailed management.
  2. To understand the different types of medications used in the management of asthma, as well as their indications and side effects.
  3. To gain knowledge on potential complications and urgent signs of worsening in asthmatic patients, as well as subsequent actions required.
  4. To understand relevant investigations in suspected asthma cases, including spirometry and other investigations as necessary.
  5. To become familiar with different clinical scenarios surrounding asthma and its management, and apply that learning to real patient cases.
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Computer generated transcript

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The following transcript was generated automatically from the content and has not been checked or corrected manually.

Asthma SBAQs- Ivy Ng 1. A 30 year-old female a ends the GP. She is diagnosed with chronic asthma and has been on salbutamol and a low dose budesonide for the last few months. However she becomes wheezier and gets short of breath much easier. You measure the peak flow, which is 80% of her best PEFR. What is the first step in the management of the pa ent? (5) a) Add montelukast b) Increase dose of budesonide c) Check adherence and inhaler technique d) Add formoterol fumarate e) Add terbutaline sulfate 2. A 12-year old girl has a previous history of shortness of breath and dry cough. She usually uses a blue inhaler to relieve her symptoms, but recently she is becoming more breathless and wheezy. Her mum is worried about the increased episodes of dyspnoea during the night. What addi onal medica on would you prescribe to the pa ent? a) Montelukast b) Salmeterol inhaler c) Oral β2 agonist d) Beclomethasone inhaler e) Theophylline 3. A 20 year old female with a history of asthma is brought into A&E with acute dyspnea and wheeze. On ini al assessment, her heart rate is 120 bpm, respiratory rate 30bpm, O2 sats <92%. She is unable to complete a full sentence. An arterial blood gas shows: pH 7.5 (7.35-7.45) PaO2 9.5kPa (11-13 kPa) PaCO2 3.3kPa (4.7-6.0kPa) HCO3 24mmol/L (22-26 mmol/L) What is the most appropriate ini al management for this pa ent? a) IV magnesium sulfate b) IV aminophylline c) High dose cor costeroid d) Oxygen e) Urgent intuba on and ven la on4. A 20 year old presents to the GP with shortness of breath. She men ons that the symptoms is worse in the morning and when the weather changes. She finds that the symptoms are exacerbated with exercise. She also suffers from atopic eczema. Which of the following is the most likely to cause the symptoms? a) Type 1 hypersensi vity mediated by IgE an bodies b) Type 1 hypersensi vity mediated by IgG an bodies c) Type 2 hypersensi vity mediated by IgE an bodies d) Type 3 hypersen vi y mediated by IgM an bodies e) Allergen 5. A 18 year old presents the GP with a 3 month history of breathlessness whilst exercising. Recently he is experiencing dyspnea at night which wakes him up some mes. Widespread wheeze is heard on ausculta on. With the suspected diagnosis, which of the following inves ga on is most likely to confirm the diagnosis? a) Chest X-ray b) Spirometry with reversibility c) Skin prick allergy test d) Sputum eosinophilia e) Bronchial challenge 6. Which of the following is not a sign of severe asthma a ack? a) Heart rate >110 bpm b) Peak flow 33-50% of predicted c) Resp rate >25 breath d) Silent chest e) Inability to complete a sentence 7. A 25 year old presents to the GP with increasing shortness of breath and chest ghtness. She has a history of asthma and is currently taking the blue and brown inhaler. Over the last 3 months, she is using the blue inhaler more o en and she is experiencing dyspnoea at night which wakes her up. Her inhaler technique is adequate. What is the next step in the management of her asthma? a) Increase dose of inhaled cor costeroid b) Oral prednisolone c) Salmeterol d) Montelukast e) Theophylline8. The pa ent presents to A&E with acute exacerba on of asthma. Ini al assessment shows O2 sats of 94%, HR 120bpm, RR 25. Peak expiratory flow rate is 40% of his best. He is unable to complete a full sentence. ABG is also performed. Which of the following criteria suggests he needs urgent intuba on and ven la on? a) O2 satura on of 94% b) Inability to complete full sentence c) PEF 40% d) Normal PaCO2 e) Heart rate 120bpm 9. A 20 year old male presents to the GP with a 3 month history of shortness of breath and ghtness in the chest. He also complains of cough in the night. The GP suspects asthma, hence a spirometry test is performed. Predicted spirometry values adjusted for age and height are: FVC 4.75L FEV1 4.0L FEV1/FVC 84% Which of the following spirometry result would you expect? a) FVC 4.70, FEV1 2.2, FEV1/FVC 47% b) FVC 4.70, FEV1 3.9, FEV1/FVC 82% c) FVC 3.25, FEV1 2.1, FEV1/FVC 65% d) FVC 2.98, FEV1 2.7, FEV1/FVC 91% 10. Which of the following is not an obstruc ve cause of lung disease? (8) a) Tuberculosis b) Asthma c) COPD d) Bronchiectasis e) Bronchioli sAnswers 1. A 30 year-old female a ends the GP. She is diagnosed with chronic asthma and has been on salbutamol and a low dose budesonide for the last few months. However she becomes wheezier and gets short of breath much easier. You measure the peak flow, which is 80% of her best PEFR. What is the first step in the management of the pa ent? (5) f) Add montelukast g) Increase dose of budesonide h) Check adherence and inhaler technique i) Add formoterol fumarate j) Add terbutaline sulfate Correct Answer: C NICE guidelines recommend checking adherence and inhaler techniques before changing or adding medica on. Long-ac ng B2 agonist would be the next medica on (BTS guidelines) to be added if both adherence and inhaler technique are correct. 2. A 12-year old girl has a previous history of shortness of breath and dry cough. She usually uses a blue inhaler to relieve her symptoms, but recently she is becoming more breathless and wheezy. Her mum is worried about the increased episodes of dyspnoea during the night. What addi onal medica on would you prescribe to the pa ent? f) Montelukast g) Salmeterol inhaler h) Oral β2 agonist i) Beclomethasone inhaler j) Theophylline Correct answer: D Low does inhaled cor costeroid is the next line of management. Long ac ng β2 agonists (salmeterol) would be needed if inhaled cor costeroid is insufficient. If LABA is insufficient in controlling the symptoms, montelukast (leukotriene receptor antagonist) is trialed. 3. A 20 year old female with a history of asthma is brought into A&E with acute dyspnea and wheeze. On ini al assessment, her heart rate is 120 bpm, respiratory rate 30bpm, O2 sats <92%. She is unable to complete a full sentence. An arterial blood gas shows: pH 7.5 (7.35-7.45) PaO2 9.5kPa (11-13 kPa) PaCO2 3.3kPa (4.7-6.0kPa) HCO3 24mmol/L (22-26 mmol/L) What is the most appropriate ini al management for this pa ent? f) IV magnesium sulfate g) IV aminophylline h) High dose cor costeroid i) Oxygen j) Urgent intuba on and ven la on Correct answer: D The pa ent has an acute exacerba on of asthma. ABG shows respiratory alkalosis which is consistent with asthma exacerba on. PaO2 is low, pa ent is hypoxic so first line would be high flow oxygen. Salbutamol would also be given back to back with oxygen via neubiliser. 4. A 20 year old presents to the GP with shortness of breath. She men ons that the symptoms is worse in the morning and when the weather changes. She finds that the symptoms are exacerbated with exercise. She also suffers from atopic eczema. Which of the following is the most likely to cause the symptoms? f) Type 1 hypersensi vity mediated by IgE an bodies g) Type 1 hypersensi vity mediated by IgG an bodies h) Type 2 hypersensi vity mediated by IgE an bodies i) Type 3 hypersen vi y mediated by IgM an bodies j) Allergen Correct answer: A 5. A 18 year old presents the GP with a 3 month history of breathlessness whilst exercising. Recently he is experiencing dyspnea at night which wakes him up some mes. Widespread wheeze is heard on ausculta on. With the suspected diagnosis, which of the following inves ga on is most likely to confirm the diagnosis? f) Chest X-ray g) Spirometry with reversibility h) Skin prick allergy test i) Sputum eosinophilia j) Bronchial challenge Correct Answer: B Asthma is a reversible obstruc ve disease. Spirometry would be reversed following bronchodilator administra on. Spirometry would show a FEV1/FVC ra o <0.7. 6. Which of the following is not a sign of severe asthma a ack? f) Heart rate >110 bpm g) Peak flow 33-50% of predicted h) Resp rate >25 breath i) Silent chest j) Inability to complete a sentence Correct answer: D Silent chest is a sign of life-threatening asthma. 7. A 25 year old presents to the GP with increasing shortness of breath and chest ghtness. She has a history of asthma and is currently taking the blue and brown inhaler. Over the last 3 months, she is using the blue inhaler more o en and she is experiencing dyspnoea at night which wakes her up. Her inhaler technique is adequate. What is the next step in the management of her asthma? f) Increase dose of inhaled cor costeroid g) Oral prednisolone h) Salmeterol i) Montelukast j) Theophylline Correct answer: C LABA should be added if SABA and low dose inhaled cor costeroid is insufficient. The pa ent is already taking SABA (blue) and beclomethasone inhaler (brown). Salmeterol is a long ac ng beta agonist. If LABA +ICS is insufficient in controlling the symptoms, the next step would be to stop LABA and increase ICS dose. 8. The pa ent presents to A&E with acute exacerba on of asthma. Ini al assessment shows O2 sats of 94%, HR 120bpm, RR 25. Peak expiratory flow rate is 40% of his best. He is unable to complete a full sentence. ABG is also performed. Which of the following criteria suggests he needs urgent intuba on and ven la on? f) O2 satura on of 94% g) Inability to complete full sentence h) PEF 40% i) Normal PaCO2 j) Heart rate 120bpm Correct answer: D Normal PaCO2 is the only criteria that suggests life-threatening asthma. The others are criteria of severe asthma. Normal or elevated PaCO2 indicates severe airway obstruc on that is leading to respiratory muscle fa gue and exhausa on, hence require intuba on. 9. A 20 year old male presents to the GP with a 3 month history of shortness of breath and ghtness in the chest. He also complains of cough in the night. The GP suspects asthma, hence a spirometry test is performed. Predicted spirometry values adjusted for age and height are: FVC 4.75L FEV1 4.0L FEV1/FVC 84% Which of the following spirometry result would you expect? e) FVC 4.70, FEV1 2.2, FEV1/FVC 47% f) FVC 4.70, FEV1 3.9, FEV1/FVC 82% g) FVC 3.25, FEV1 2.1, FEV1/FVC 65% h) FVC 2.98, FEV1 2.7, FEV1/FVC 91% Correct answer: A Asthma is a obstruc ve disease, o en with a low FEV1 and FEV1/FVC<0.7. FVC is o en preserved. D is typical for restric ve disease. 10. Which of the following is not an obstruc ve cause of lung disease? (8) f) Tuberculosis g) Asthma h) COPD i) Bronchiectasis j) Bronchioli s Correct answer: A Tuberculosis is a restric ve disease.