Case 1: 35 year old man with asthma. - wheezy since birth with triggering agents including upper respiratory tract infections, exercise, dog hair, and house dust mites. - admitted to hospital today by his general medical practitioner because of worsening symptoms and difficulty taking his medications. - currently using two metered dose inhalers with a spacer for the delivery of his medications - Salbutamol (Ventolin), a sympathomimetic (B2-agonist) and beclomethasone dipropriate (Becotide) - persistent, non-productive cough, expiratory wheezes and laboured breathing - appears flushed and very anxious and is having difficulty completing sentences. Arterial blood gases on admission • SaO2 = 94 (FiO2 = 0.4) • PaO2 (on O2) = 10 kPa (135mm Hg) • PaCO2 (on O2) = 4.1 kPa (31mmHg) • pH = 7.47 On examination • Heart Rate (HR) = 100beats /min • Temperature = 37.8 oC • Respiratory Rate (RR) = 28 breaths/min (shallow, prolonged expiration; short, gasping inspiration) • FEV1/FVC ratio = 65% • Auscultation – reduced breath sounds throughout the lung fields with widespread expiratory wheeze 1. The patient’s chest X-ray is likely to show evidence of

2. The patient’s FEV1/FVC ratio indicates he has

3. What is the rationale for using a spacer for the delivery of Becotide in the patient’s case?

4. Becotide has which of the following actions?

5. Sympathomimetic drugs

6. Which of the following is true with regard to the patient’s inhaled medications?