Asthma & COPD Treatment

Question 1

What is 1st line tx for asthma according to GINA 2019?

Answer 1

reliever
low dose budesonide/formoterol PRN (provides relief just as quickly as SABA)
alt: SABA and low dose ICS at the same time

Question 2

What are 2nd-5th line tx options for asthma according to GINA 2019?

Answer 2

2nd line: low dose ICS prn or daily alt LTRA
3rd line: daily low dose ICS/LABA alt ICS+LTRA
4rth line: daily med dose ICS/LABA alt +/- tiotropium or LTRA
5th line: daily high dose ICS/LABA alt +/- OCS

Question 3

ICS AE

Answer 3

Sore mouth, sore throat, dysphonia, oral thrush (can be reduced by rinsing mouth or using spacer).

Question 4

SABA/LABA AE

Answer 4

Nervousness, tremor, tachycardia, palpitations.

Question 5

SAMA/LAMA AE

Answer 5

Dry mouth, metallic taste; mydriasis and glaucoma if released into eye.

Question 6

What is used to treat asthma in children?

Answer 6

SABA PRN, ICS+/-LABA maintenance, tiotropium adjunct

Question 7

What is used to treat COPD in patients with:
0-1 exacerbations
no hospitalizations
mMRC 0-1

Answer 7

SABA or SAMA PRN

GOLD Group A

Question 8

What is used to treat COPD in patients with:
0-1 exacerbations
no hospitalizations
mMRC 2-4

Answer 8

LAMA or LABA

GOLD Group B

Question 9

What is used to treat COPD in patients with:
>2 exacerbations
hospitalizations
mMRC 0-1

Answer 9

LAMA

GOLD Group C

Question 10

What is used to treat COPD in patients with:
>2 exacerbations
hospitalizations
mMRC 2-4

Answer 10

LAMA or LAMA/LABA or ICS/LABA or ICS/LAMA/LABA

GOLD Group D

Question 11

What are tx options for COPD patients symptomatic despite ICS/LAMA/LABA?

Answer 11

theophyline
roflumilast
n-acetylcysteine

Question 12

What are tx options for asthma patients symptomatic despite optimizing inhalers?

Answer 12

montelukast
theophyline
sodium cromoglycate 
omalizumab
mepolizumab, benralizuman, reslizumab

Question 13

How are asthma exacerbations treated?

Answer 13

SAMA/SABA
PO/IV Corticosteroids (Prednisone x7-14d)
NO antibiotics

Question 14

How are COPD exacerbations treated?

Answer 14

SAMA/SABA
Corticosteroids (Prednisone x5d)
Antibiotics if on ventilator or 2 of: dyspnea, sputum, purulence: Amox, Doxy, Septra (consider others if >4 exacerabations/yr, may use azithro preventatively)

Question 15

mMRC dyspnea scale

Answer 15

dyspnea with
0-strenuous exercise
1-hurrying or walking uphill
2-walking slower than normal
3-walking 100m/few min
4-dressing, unable to leave house
used for COPD

Question 16

Drugs in each class used in asthma

Answer 16

SABA: salbutamol, terbutaline
SAMA: ipratropium
LABA: formoterol, salmeterol, vilanterol
LAMA: tiotropium
ICS: beclomethasone, budesonide, ciclesonide, fluticasone, mometasone

Question 17

Drugs in each class used in COPD

Answer 17

SABA: salbutamol, terbutaline
SAMA: ipratropium
LABA: formoterol, INDACATEROL
LAMA: tiotropium, GLYCOPYRRONIUM, ACLIDINIUM, UMECLIDINIUM
ICS: beclomethasone, budesonide, ciclesonide, fluticasone, mometasone

Question 18

What are the 4 Qs in the GINA assessment for asthma control?

Answer 18

In the past 4 weeks have you had:
-daytime sx more than 2/wk
-night waking due to sx
-reliever needed more than 2/wk
-activity limitation due to sx
0=well controlled
1-2=partly controlled
3-4=uncontrolled

Question 19

A well controlled asthmatic should only need how many canisters of SABA per year

Answer 19

1-2 salbutamol MDI

2-4 terbutaline DPI

Question 20

once daily corticosteroids should be dosed at what time in children

Answer 20

in the morning to minimize HPA suppression (sx include growth suppression)