Pharmacology - Asthma

Question 1

Very mild asthma management

80% or better lung function PRE-bronchodilator
2 attacks/wk (only 1/day)
2 nightly exacerbation/mo. Must stop activity during attack

Answer 1

1) Asthma education and environmental control
2) As needed SABA
*************
SABA - Salbutamol (Ventolin), Terbutaline (Bricanyl), Fenoterol (Berotec)

Question 2

Mild asthma management

80% or better lung function Pre-bronchodilator More than: 2 attacks/wk (only 1/day), 2 nightly exacerbation/mo.
But no daily symptoms, disruption in normal activities, night exacerbation less than once a week

Answer 2

1) Asthma education and environmental control
2) As needed SABA
3a) low dose ICS
or
3b) leukotriene modifier
************
SABA - Salbutamol (Ventolin), Terbutaline (Bricanyl), Fenoterol (Berotec)

ICS - Budesonide (Pulmicort), Fluticasone (Flovent)

Leukotriene - Montelukast (Singulair), Zafirlukast (Accolate)

Question 3

Moderate asthma management
60-80% lung function Pre-bronchodilator
Daily symptoms (coughing, wheezing) and can last several days.
Disrupts normal activities. 
Night exacerbation once a week or more

Answer 3

1) Asthma education and environmental control
2) As needed SABA
3a) low dose ICS + LABA
or
3b) Medium or high does ICS
or
3c) Low dose ICS + leukotriene modifier
or
3d) Low dose ICS + Sustained release theophylline
*****************
SABA - Salbutamol (Ventolin), Terbutaline (Bricanyl), Fenoterol (Berotec)

ICS - Budesonide (Pulmicort), Fluticasone (Flovent)

LABA - Formoterol, Salmeterol (Serevent)

Leukotriene - Montelukast (Singulair), Zafirlukast (Accolate)

Question 4

Moderate severe asthma management

Daily symptoms (coughing and wheezing) more than once a day. Activity’s are disrupted, Sleep disrupted. Less 60% lung function pre-bronchodilator.

Answer 4

1) Asthma education and environmental control
2) As needed SABA
3a) medium or high dose ICS + LABA
and/or
3b) Leukotriene modifier
and/or
3c) Sustained release theophylline
*****************
SABA - Salbutamol (Ventolin), Terbutaline (Bricanyl), Fenoterol (Berotec)

ICS - Budesonide (Pulmicort), Fluticasone (Flovent)

LABA - Formoterol, Salmeterol (Serevent)

Leukotriene - Montelukast (Singulair), Zafirlukast (Accolate)

Question 5

Severe asthma management

Daily symptoms (coughing and wheezing) more than once a day. Activity’s are disrupted, Sleep disrupted. Less 60% lung function pre bronchodilator.BUT less than 60% lung function POST bronchodilator.

Answer 5

1) Asthma education and environmental control
2) As needed SABA
3a) Oral gluccocorticoid
and/or
3b) Anti-IgE treatment
*****************
SABA - Salbutamol (Ventolin), Terbutaline (Bricanyl), Fenoterol (Berotec)

Oral gluccocorticoid -

Anti-IgE -

Question 6

Asthma - Roll of Drug Therapy

Relievers

Answer 6

Relievers - SABA for acute symptoms (DOC for rescue medication and short term prevention of exercise-induced bronchospasm)

Question 7

Asthma - Roll of Drug Therapy

Controllers/Preventers

Answer 7

Controllers/Preventers - anti-inflammatory medications such as ICS, LTRA’s, cromoglycate and nedocromil