Management of Asthma- Adults

Question 1

What cells are responsible for the effects of asthma?

Answer 1

Th2 Cytokines - (IL-5, LT)

Eosinophils

Mast cells

Question 2

What is the difference between occupational asthma and work-exacerbated asthma?

Answer 2

Occupational has no prior history of asthma

Question 3

What is non-pharma management of chronic asthma?

Answer 3

Asthma Action Plan

Weight loss if ˄BMI

Vaccines – flu & pneum

Allergen avoidance

(inc. occup. Asthma)

Physiotherapy

Smoking Cessation

Bronchial Thermoplasty

Question 4

What are the drugs used to treat acute asthma attack and chronic asthma?

Answer 4

Question 5

What are the drugs to avoid during the treatment of asthma?

Answer 5

β-blockers

NSAIDS / Aspirin

Sedatives/strong opiates (unless in critical care)

Question 6

What are the non-pharma methods of treatment of acute asthma attack?

Answer 6

ITU/HDU

Ventilation

ECCO2R

Chest drain if

pneumothorax

Question 7

What are the benefits of inhalers?

Answer 7

• Small dose of drugs
• Delivery directly to the target organ (airways and lung)
• Onset of effect is faster
• Minimal systemic exposure
• Systemic adverse effects are less severe and less frequent

Question 8

What are the problems associated with metered dose inhalers?

Answer 8

• Needs co-ordination
• Elderly, young children, unwell can’t use effectively

Question 9

What are the benefits of spacers?

Answer 9

• Low oro-pharyngeal deposition of aerosol
• Reduced speed of the aerosol
• decreases bad taste associated with oral deposition
• reduced the risk of oral candidiasis and dysphonia with steroids
• Reduced “cold-Freon effect” in some

Question 10

What are the benefits associated with dry powder inhalers?

Answer 10

• Less coordination required
• Similar issues with deposition

Requires high inspiratory flow

Question 11

What does SABA stand for?

Answer 11

Short acting beta 2 agonists

Question 12

Where do you find salbutamol?

Answer 12

MDI

DPI

Question 13

Where do you find terbutaline?

Answer 13

DPI

Question 14

What are the adverse side effects of beta 2 stimulants?

Answer 14

Question 15

What are regular preventers?

Answer 15

Low dose Inhaled Corticosteroids (ICS) - Preventers

• Beclomethasone
• Budesonide
• Fluticasone
• Ciclesonide
• Mometasone

Question 16

When do you start ICS?

Answer 16

• Using inhaled β2 agonist (“Reliever”) x3/week or more
• Waking one night a week or more due to asthma
• Requiring oral steroid for an exacerbation in the past 2 years
• Symptomatic x3/week or more

Question 17

What are the advantages of inhaled ICS?

Answer 17

Question 18

What are the side effects of Long term oral cortical steroid use?

Answer 18

Question 19

What are the long term side effects of inhaled long term steroids?

Answer 19

Dysphonia - difficulty in speaking due to a physical disorder of the mouth, tongue, throat, or vocal cords.

•Oropharyngeal Candidiasis

Question 20

When do you move up the steps from SABA to ICS?

Answer 20

If it is being used three times a week

Question 21

WHat is the first stage of management after Asthma diagnosed

Answer 21

Regular preventer

Add inhaled low-dose ICS

Question 22

What is the 2nd stage of treating asthma

Answer 22

Initial add-on therapy

Add inhaled LABA to low dose ICS

Question 23

Additional add on therapy

What should you do if there is no response to LABA?

Answer 23

Stop using it and consider an increased dose of ICS

Question 24

Additional add on therapy

What should you do if there is a benefit from LABA but control is still inadequate?

Answer 24

Continue LABA and increase ICS to medium dose

Or Continue LABA and ICS and consider LRTA, SR theophylline, LAMA

Question 25

What are the possible high dose therapies?

Answer 25

Increasing the ICS up to high dose

Addition of a fourth drug - LRTA, SR theophyline, beta agonist tablet, LAMA

Question 26

What is the very last stage of asthma treatment?

Answer 26

Daily steroid tablets

Maintain high dose ICS

Consider other treatments to minimise the use of steroids

Question 27

Give examples of Leukotrine receptor antagonists

Answer 27

Montelukast

•Zafirlukast

Question 28

What is theophylline?

Answer 28

Phosphodiesterase inhibitor

Adenosine receptor antagonist

Weak bronchodilator

Question 29

What are the downsides to using Theophylline?

Answer 29

Many side effects

Narrow therapeutic window

Unpredictable metabolism - interacts with many drugs

Question 30

Give an example of a long term oral steroid

Answer 30

Prednisolone

Question 31

What dose is recommended for long term oral steroids?

Answer 31

Lowest oral dose that controls symptoms

Question 32

What is the cytokine that is responsible for driving the hypersensitivity in asthma?

Answer 32

Interleukin - 5

Question 33

What are the non-pharmacological methods of asthma management?

Answer 33

Patient education and self-management plans

Inhaler technique

Smoking cessation

Vaccinations (flu/pneumococcal)

Allergen avoidance - removal needed if occupational asthma

Bronchial thermoplasty - heating parts of the airway with a heater probe

Question 34

Acute asthma

What is defined as moderate asthma?

Answer 34

Question 35

What is defined as acute severe asthma?

Answer 35

Question 36

Acute asthma

What is defined as life-threatening asthma?

Answer 36

Question 37

What is defined as near fatal asthma?

Answer 37

Raised PaCO2 and/or requiring mechanical ventilation with raised inflation pressures (504-507)

Question 38

What is the treatment of acute asthma - mild/moderate?

Answer 38

Question 39

What is treatment for acute asthma - severe?

Answer 39

Ipratropium is a short acting muscarinic drug

Nebulisers- salbutamol/Ipratropium

Oral/IV steroid

MASH

Level ⅔ care