Asthma

Data gathering

• Red flags
  • weight loss, haemoptysis
• Others
  • triggers, night cough, inhaler frequency, technique, PO steroids/ITU admissions
  • parental smoking
  • pets
• Examine
  • general respiratory exam
  • observations: sats, RR, HR
  • other
    • peak flow
    • inhaler technique

Clinical management

• Investigations
  • spirometry with reversibility testing, PEFR diary
  • CXR

• Explanation
  • muscles of airway walls tighten so airway becomes more narrow. the lining also gets inflamed furthering narrowing the airways.

• Treatment
  • Lifestyle – smoking cessation, allergen avoidance
  • stepwise (SABA -> inhaled steroid 400mcg -> LABA -> montelukast -> PO steroids)

• Follow-up / Safety net

Oral corticosteroid doses for asthma exacerbations

• Adult or child over the age of 12 years – 40–50 mg once a day for 5 days.
• Child 6 to 12 years – 30–40 mg once a day for 3 days.
• Child 2 to 5 years – 20 mg once a day for 3 days.
• Child under 2 years – 10 mg once a day for 3 days.