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01. Respiratory System - HP > Adult Asthma Management > Flashcards

Adult Asthma Management Flashcards

1
Q

What investigations can be carried out in the diagnosis of asthma?

A
  • Peak flow monitoring
  • Spirometry
  • Bronchodilator reversibility
  • Blood tests
  • Allergy tests
  • Bronchia; hyper-responsiveness
  • Exhaled NO
  • CXR in some patients
  • Challenge testing
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2
Q

What is occupational asthma?

A
  • Symptoms related to work exposure

- No prior history of asthma

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3
Q

What is work exacerbated asthma?

A
  • Symptoms related to work exposure

- Prior history of asthma

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4
Q

What non-pharmacological management is there for acute asthma attack?

A
  • ITU/HDU
  • Ventilation
  • ECCO2R
  • Chest drain if pneumothorax
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5
Q

What non-pharmacological management is there for chronic asthma?

A
  • Asthma action plan
  • Weight loss if high BMI
  • Vaccines
  • Allergen avoidance
  • Physiotherapy
  • Smoking cessation
  • Bronchial thermoplasty
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6
Q

What drugs should be avoided in asthma?

A
  • Beta blockers
  • NSAIDs/aspirin
  • Sedatives/ strong opiates unless in critical care
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7
Q

What bronchodilators are used in asthma management?

A
  • B2 agonists (b)
  • Anti-muscarinincs (b)
  • Theophyllines (b)
  • Magnesium (a)
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8
Q

What anti-inflammatories are used in asthma management?

A
  • Steroids (b)
  • Leukotriene RAs (c)
  • Monoclonal Abs (c)
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9
Q

Why are inhalers used in chronic asthma management?

A
  • Small doses
  • Delivery directly to the target organ
  • Onset of effect is faster
  • Minimal systemic exposure
  • Systemic adverse effects are less severe and less frequent
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10
Q

Describe the use of pMDI.

A
  • Needs co-ordination
  • Elderly, young children and the unwell can’t use effectively
  • Generates aerosol: low inspiratory flow
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11
Q

What are the advantages of using pMDI with a spacer?

A
  • Low oro-pharnygeal 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
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12
Q

Describe the use of DPI.

A
  • Patient generates aerosol: high inspiratory flow
  • Less coordination required
  • Similar issues with deposition
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13
Q

What is complete control of asthma defined as?

A
  • No daytime symptoms
  • No night time awakening due to asthma
  • No need for rescue medication
  • No asthma attacks
  • No limitation on activity and normal lung function
  • Minimal side effects
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14
Q

What forms do SABA relievers come in?

A
  • Salbutamol as MDI or DPI

- Terbutaline as DPI

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15
Q

What are the adverse effects of oral B2 agonists?

A
  • Tremor
  • Cramp
  • Headache
  • Flushing
  • Palpitations
  • Angina
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16
Q

What ICS preventers are there?

A
  • Beclomethasone
  • Budesonide
  • Fluticasone
  • Ciclesonide
  • Mometasone
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17
Q

When should ICS be started?

A
  • Using inhaled B2 agonist 3x or more per week
  • Waking 1x or more a week due to asthma
  • Requiring oral steroid for an exacerbation in the past 2 years
  • Symptomatic 3x or more a week
18
Q

What are the advantages of ICS?

A
  • Low dose
  • Delivered to the site of action
  • Minimal side effects
19
Q

What are the long term effects of inhaled steroids?

A
  • Dysphonia

- Oropharyngeal candidiasis

20
Q

What are the long term effects of oral steroids?

A
  • Red cheeks
  • Fat pads
  • Thin skin
  • Hypertension
  • Thin limbs
  • Moon face
  • Bruisability ecchymoses
  • Red striations
  • Pendulous abdomen
  • Osteoporosis
  • Poor wound healing
21
Q

What ICS and LABA combinations are there?

A
  • Fostair (pMDI + DPI)
  • Symbicort (DPI)
  • DuoResp SpiroMax (DPI)
  • Flutiform (pMDI)
  • Seretide (pMDI + DPI)
  • Relvar Ellipta (DPI)
22
Q

What LTRA are there?

A
  • Montelukast

- Zafirlukast

23
Q

What is important about LTRA?

A
  • More effective in those highly allergic
  • Response is difficult to predict
  • Worth a 6-12 week trial in some patients
24
Q

What is theophylline?

A
  • Non specific phosphodiesterase inhibitor and adenosine receptor antagonist
  • Weak bronchodilator
25
Q

What are the side effects of theophylline?

A
  • Anorexia
  • Headache
  • Nausea
  • Malaise
  • Vomiting
  • Nervousness
  • Abdominal discomfort
  • Insomnia
  • Tachycardia
  • Tachyarrhythmias
  • Convulsions
26
Q

What are the disadvantages of theophylline?

A
  • Narrow therapeutic window

- Unpredictable metabolism- interact with many drugs

27
Q

What is the most common form of LAMA?

A

Tiotropium bromide via Spiriva Respimat device

28
Q

What do LAMAs do?

A

Antagonise muscarinic acetylcholine receptor in bronchial smooth muscle

29
Q

What are the side effects of LAMAs?

A
  • Dry mouth
  • GI upset
  • Headaches
  • Can rarely precipitate angle-closure glaucoma
30
Q

What is the main long term oral steroid?

A

Prednisolone

31
Q

What can happen if prednisolone is suddenly stopped after 3+ week use?

A

-Acute adrenal insufficiency

32
Q

What is omalizumab?

A

Monoclonal antibody against IgE

33
Q

What is mepolizumab?

A

Monoclonal antibody against interleukin-5

34
Q

When is mepolizumab usually started?

A

Poor asthma control with blood eosinophilia

35
Q

What examples of immune suppressive drugs are there?

A
  • Methotrexate
  • Ciclosporin
  • Oral gold
36
Q

Why are immune suppressive drugs often used as a last resort?

A

They can have significant side effects

37
Q

What non-pharmacological measures are there?

A
  • Patient education and self management plans
  • Inhaler technique
  • Smoking cessation
  • Flu/ pneumococcal vaccinations
  • Allergen avoidance
  • Bronchial thermoplasty
38
Q

What non-pharmacological management is there for occupational asthma?

A

Prompt removal from inhalation exposure

39
Q

What is the management for mild/moderate acute asthma?

A
  • Oral prednisolone (0.5mg/kg/day) for 7 days
  • SABA up to 2 hourly
  • Increase ICS/LABA dose
  • Assess within 24 hours
  • Advice immediate medical help if deteriorating
40
Q

What is the management for severe acute asthma?

A
  • Admission to hospital
  • Oral/ IV steroids
  • Nebulised bronchodialators- SABA/SAMA
  • Oxygen
  • Consider IV MgSo4 if no response
  • Antibiotic is infection
  • CXR
  • May require ITU, intubation and ventilation or ECCO2R

01. Respiratory System - HP (82 decks)

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