Respiratory: Asthma Flashcards
What is step 1 in adults and children over 5 for mild intermittent asthma?
Start inhaled short-acting beta2 agonist (such as salbutamol or terbutaline sulfate) as required
Move to step 2 if the patient presents with any one of the following features; is using an inhaled beta2 agonist three times a week or more, being symptomatic three times a week or more, experiencing night-time symptoms at least once a week, or has had an asthma attack in the last 2 years.
What is step 2 asthma treatment in adults and children over 5?
Consider adding regular inhaled standard-dose corticosteroid (alternatives to inhaled corticosteroid are leukotriene receptor antagonists, theophylline, inhaled sodium cromoglicate, or inhaled nedocromil sodium, but are less effective)
Adult and children over 12 years should have regular preventer therapy, if needed, of how many mcg/day beclometasone or equivalent?
Adult and child over 12 years: 200–800 micrograms/day beclometasone dipropionate or equivalent
Child 5–12 years: 200–400 micrograms/day beclometasone dipropionate or equivalent
Adult and children UNDER 12 years should have regular preventer therapy, if needed, of how many mcg/day beclometasone or equivalent?
Adult and child over 12 years: 200–800 micrograms/day beclometasone dipropionate or equivalent
Child 5–12 years: 200–400 micrograms/day beclometasone dipropionate or equivalent
Beclometasone dipropionate and _______ are approximately equivalent in clinical practice although there may be variations with different drug delivery devices.
Beclometasone dipropionate and budesonide are approximately equivalent in clinical practice although there may be variations with different drug delivery devices.
Fluticasone and mometasone furoate provide equal clinical activity to beclometasone dipropionate and budesonide at what dosage?
Fluticasone and mometasone furoate provide equal clinical activity to beclometasone dipropionate and budesonide at half the dosage.
Inhaled corticosteroids (except for what?) should be initially taken twice daily, however, the same total daily dose can be considered once a day if good control is established.
Inhaled corticosteroids (except ciclesonide) should be initially taken twice daily, however, the same total daily dose can be considered once a day if good control is established.
In children, administration of high doses of inhaled corticosteroids may be associated with systemic side-effects, including what? (3)
In children, administration of high doses of inhaled corticosteroids may be associated with systemic side-effects, including growth failure, reduced bone mineral density, and adrenal suppression
In adults and children over 5, what is step 3 management of asthma?
Consider adding a regular inhaled long-acting beta2 agonist (LABA) such as formoterol fumarate or salmeterol [Serevent, Neovent] (or, in adults only, indacaterol [Onbrez Breezhaler] or olodaterol [Striverdi Respimat]) to be used in conjunction with an inhaled corticosteroid.
At step 3 of asthma management (adults and children over 5), if the patient is gaining some benefit from addition of LABA but control is inadequate, what is the next step?
If the patient is gaining some benefit from addition of a LABA but control is inadequate then continue the LABA and increase dose of inhaled corticosteroid to top end of inhaled standard-dose corticosteroid range. If there is no response to the LABA, discontinue and increase dose of inhaled corticosteroid. If control is still inadequate, start a trial of either a leukotriene receptor antagonist (montelukast, or zafirlukast if over 12 years) or modified-release theophylline.
At step 3 of asthma management (adults and children over 5), if there was some response to LABA but the ICS needed to be increased and yet this still resulted in inadequate control, what is the next step?
If control is still inadequate, start a trial of either a leukotriene receptor antagonist (montelukast, or zafirlukast if over 12 years) or modified-release theophylline.
Zarifilukast can only be used in what age groups?
12+
What is step 4 treatment of asthma (adults and children over 5)?
Options to consider:
> Increased dose of ICS OR
> LTRA, MR theophylline or MR oral beta2 agonist [cautioned in people already taking LABA]
Adults and children 12 and up: up to 2000mcg/day of beclometasone or equiv.
Achild 5-12: 800micrograms/day beclo or equivalent.
For step 4 treatment of asthma in adults and children over 5, one of the options is to increase the dose of ICS. What can this be increased to?
Adults and children 12 and up: up to 2000mcg/day of beclometasone or equiv.
Achild 5-12: 800micrograms/day beclo or equivalent.
Other options are:
LTRA, MR theophylline or MR oral beta 2 agonist
What is step 5 treatment of asthma in adults and children over 5?
The regular use of an oral corticosteroid (e.g. prednisolone, as a single daily dose) at lowest dose to provide adequate control; continue the high-dose inhaled corticosteroid to minimise oral requirements as much as possible.
