Respiratory answers:

1) 50-75%, 33-50%
2) Oxygen, SABA, steroids, ipratropium, magnesium
3) Maintenance and reliever therapy
4) Duoresp spirimax <18 (budesonide and formoterol), fostair (beclomethasone,
formoterol) <18, Symbicort <12 (budesonide, formoterol)
5) SABA, Low dose ICS, LABA, Additional add ons (a- remove LABA if x work, incr ICS, b-
incr ICS keep LABA, c-keep LABA and add a third option ie LTRA theophylline),
specialist i.e. add fourth drug, oral steroid
6) Every 3 months
7) Beclometasone 500micrograms (fine particles) 2 doses, standard particles 1200
(clenil) micrograms 2 doses, fluticasone proprionate 600mcg in 2 doses, fluticasone
furoate 200mcg as a single dose, mometasone 800mcg in 2 doses, budesonide
1000mcg in 2 doses
8) SABA, very low ICS, add LTRA/LABA, additional add ons (stop LABA if no response
and incr ICS to low dose, incr ICS dose and keep LABA, consider other option ie LTRA)
9) Bambuterol
10) Hand tremors, tachycardia, hyperglycaemia, hypokalaemia, prolonged QT interval
11) QVAR, more potent. Clenil less potent
12) Hoarse voice, sore throat, oral candidiasis, paradoxical bronchospasm
13) Churg Strauss syndrome, liver toxicity (with zafirlukast)
14) Xanthine bronchodilator
15) 10-20mg/L
16) Five days after initiation or 3 days after a dose change, take 4-6 hours after an oral
MR preparation
17) Smoking decreases the concentration of theophylline in the blood, stopping smoking
causes an increase of theophylline concentration (monitor for toxicity)
18) SABA, low dose ICS, LTRA (RV in 4-8 weeks), LABA, (+/- LTRA), if still uncontrolled
offer to change ICS and LABA to MART regimen, if this still doesn’t work increase ICS
to medium
19) SABA, very low ICS, LTRA, remove LTRA add LABA, Use as MART
20) SABA, very low ICS or LTRA <5, add LABA or LTRA or only LTRA <5,
21) Emphysema: Pink puffer- frequent pink complexion, fast RR and pursed lips. Chronic
bronchitis- blue bloaters due to bluish colour of skin and lips, cyanosis and swollen
ankles
22) SABA or SAMA PRN
23) Annual influenza and pneumococcal vaccine
24) SAMA/SABA PRN, LABA or LAMA (disc SABA if LAMA given), then add ICS, then triple
therapy (LABA, LAMA, ICS)
25) SABA/SAMA PRN, ICS with LABA, then triple therapy
26) 5 days after commencing therapy, 3 days after changing the dose and 4-6 hours after
oral MR dose taken
27) IM as too irritant (20x more soluble than theophylline)
28) Once daily (except for Eklira which is BD- aclidinium)
29) Glycopyrronium (Seebri breezhaler), umeclidinium (Incruse Ellipta), tiotropium
(spriva handihaler)
30) 7-14 days (30mg) [asthma is 5 days minimum]
31) Azithromycin (unlicensed) used if 4 or more exacerbations per year resulting in
hospital. NB: never give macrolides with azithromycin
32) Only be added if control with ICS has failed, not be initiated in deteriorating asthma,
introduce at a low dose, be discontinued in absence of benefit etc
33) 94-98%, but 88-92% in chronic respiratory failure ie COPD, CF etc
34) Self-limiting, paracetamol and ibuprofen to control fever and pain. If taken into hosp:
corticosteroid (Dexamethasone) by mouth
35) 150 micrograms 1 month – 5 years, 300 micrograms 6-11 years, 500 micrograms 12
years and above
36) Always carry 2, patient and carers with allergies trained on how to use and practice
with training device, check expiry dates and obtain replacements before expiry
37) Dornase alfa, hypertonic saline, mannitol (think about pancreatin, fluids)
38) >6
39) >12
40) tablet >16 (nytol)
41) >12
42) >12
43) >6
44) 12
45) >2 for syrup and tablets
46) Tabs <6, solution <2
47) >18