A Quick Guide to the Routine Management of Asthma in Primary Care

Take a quick survey to test your knowledge

This Quick Guide is based on the new revised 2008 British Guideline on the Management of Asthma and the NICE guidance on the use of inhaled steroids in the management of asthma. We'd like you to take the short survey on this page before you look at the guide, but to go directly to the guide, click here.

Self-assessment Survey
Are you a member of the PCRS UK? a. Yes b. No	What is your profession? a. GP b. Primary care nurse c. Secondary care nurse/respiratory nurse specialist d. Other
Question 1 (a) Diagnosis (choose one of the following) In which group of children should clinicians take the following approach? Watchful waiting with review: a. those with a high probability of asthma b. those with a low probability of asthma c. those with an intermediate probability of asthma	Question 1 (b) To help make a diagnosis of asthma in adults, which one of the following is considered to be a significant improvement in FEV₁ after a reversibility test in the UK? a. 200ml b. 400ml c. 10%
Question 2 Non-pharmacological management Studies of individual aeroallergen avoidance strategies show which one of the following statements to be true? a. limited or of no benefit b. cost effective c. removal of the domestic pet leads to improved asthma outcomes	Question 3 Pharmacological management adults In an adult using short-acting beta-2-agonists 8-10 times per week, over the past 3 months, who is already taking 400mcg per day of BDP, which of the following is recommended? a. The addition of a long- acting beta-2-agonist (LABA) b. Stepping-up (increasing) the dose of inhaled corticosteroids (ICS) to 800mcg per day c. A short course of oral steroids to regain control d. An asthma review including inhaler technique and concordance, then add LABA if these are satisfactory e. Switch to a different ICS
Question 4 Pharmacological management children What is the maximum dose of inhaled steroid in a 7-year old poorly controlled asthmatic child, before adding additional therapy or referring? The child has perfect inhaler technique. (more than one answer possible) a. Clenil^R Modulite^R 100mcg 2 puffs bd b. CFC BDP 100mcg bd c. Fluticasone 100mcg bd d. Budesonide 200mcg bd e. Qvar 50mcg bd	Question 5 Assessment of acute asthma According to the guidelines, when assessing an adult, which one of the following is a cardinal sign of life threatening asthma? a. Pulse rate 120 beats per min b. Respiratory Rate 32 per min c. Pulse oximetry (sPO2) 91% d. Widespread wheeze in the chest e. inability to talk in sentences
Question 6 Treatment of acute asthma Identify which statement is true from those listed. According to the guidelines, patients who have been treated for acute severe asthma: a. Should have their bronchodilators given via nebuliser b. Should be admitted until their PEF returns to >80% c. May be treated in a pre-hospital environment using IV Magnesium d. Should be given a personal asthma action plan e. Should be reviewed in practice within 48hrs - their GP having been notified	Question 7 Asthma in Pregnancy Which one group of the following drug types should not be initiated in pregnancy? a. inhaled steroids b. oral steroids c. theophyllines d. leukotriene receptor antagonists
Question 8 Organisation and delivery of care, and audit Which one of the following recommendations for routine delivery of asthma care in general practice has Grade A evidence? a. Clinical review should be structured and utilise a standard recording system b. General practices should maintain an up-to-date register of people with asthma c. People with asthma should be reviewed regularly by a doctor or a nurse with appropriate training in asthma management d. Carrying out routine reviews by telephone for people with asthma may be as effective as face-to-face consultations	Question 9 Patient education and self management The guidelines recommend that a personalised asthma action plan should have which one of the following characteristics: a. be symptoms only based b. have 4 or more action points c. be based on peak flow only d. advise patients to go straight to the oral steroid step if they are already taking >400mcg of inhaled steroid normally
Question 10 Occupational asthma A 43 year old welder develops symptoms suggestive of asthma. What would you advise? (more than one answer possible) a. He should come off work and avoid exposure to potential allergens b. He should do PEF measurements twice daily to confirm diagnosis c. He should stop smoking d. He should be told to seek compensation to which they will be entitled e. He should be referred for specialist assessment