Asthma Flashcards by Molly Moss

What is chronic asthma?

Reversible obstructive airways disease

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What are the symptoms of chronic asthma?

Coughing, especially at night
Shortness of breath
Chest tightness
Wheezing

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What are the SABAs?

Short acting bronchodilators

Salbutamol
Terbutaline

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What steps in the guidelines do you use a reliever for chronic asthma?

All steps

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What are the alternatives to SABAs?

Ipratropium bromide (SAMA)

If over 12 - Theophylline or oral B2 agonist (bambuterol)

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When should you step up the management of asthma?

If using inhaler or symptomatic at least 3 times a week

Night time symptoms at least once a week

Asthma attack requiring systemic steroids in last 2 years

Refer is using > 1 inhaler a month

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What is step 1 of the asthma guideline?

Low dose inhaled corticosteroids

Start BD then reduce to OD if good control

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What are the low dose ICS used in step 1 of asthma management?

Mometasone
Fluticasone 
Beclometasone
Budesonide
Ciclesonide

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What are the alternatives to low dose ICS used in step 1 of asthma management?

Leukotriene receptor antagonist

Theophylline

Inhaled sodium cromoglicate

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What is step 2 of the asthma management guidelines?

Add LABA to low dose ICS

Combination inhaler

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What are the LABAs used in step 2 of the asthma management?

Formoterol

Salmeterol

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What is step 3 part 1 of the asthma guidelines?

No response - stop LABA and increase ICS dose

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What is step 3 part 2 of the asthma guidelines?

If benefit but control still adequate

Continue LABA

Increase to medium dose ICS

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What is step 3 part 3 of the asthma guidelines?

If benefit but control still inadequate

Continue LABA

Trial LTRA
LAMA
Or SR theophylline

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What is step 4 of the asthma management guidelines?

Add fourth drug + high dose ICS

SR theophylline

LAMA - tiotropium bromide

LTRA - montelukast, zafirlukast

Oral B2 agonist tablet - bambuterol

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What is step 5 of the asthma guidelines?

Add oral prednisolone

Single dose OM to prevent insomnia
Gradually withdraw when stepping down

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What is the mechanism of action of the selective B2 agonists?

Causes bronchodilation of the bronchi

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What are the inhaled short acting B2 agonists?

Salbutamol QDS PRN

Terbutaline QDS PRN

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What are the inhaled long acting B2 agonists?

Formoterol BD

Salmeterol BD

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What are the other LABAs used in COPD?

Olodaterol
Indacaterol
Vilanterol with umeclidinium

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What is vilanterol used with in asthma?

Fluticasone

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What is the oral B2 agonist tablet?

Bambuterol

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What is salmeterol used for?

Long onset + long action

Not for acute relief or prevention of exercise induced asthma

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What is formoterol used for?

Short onset + long action

Relievers and preventer
Rv if using more than once a day

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What is in fostair?

Beclometasone + formoterol

What is in duoresp spiromax?

Budesonide + formoterol

What is in symbicort?

18 years + | Budesonide + formoterol

What are the side effects of selective B2 agonists?

``` Hand tremors Tachycardia Hyperglycaemia Hypokalaemia CV events ```

How do the inhaled corticosteroids work?

Reduces inflammation in the bronchi

Which inhaled corticosteroids have a twice daily dosing?

Beclometasone Budesonide Fluticasone Mometasone (BD/OD)

Which inhaled corticosteroids have a once daily dosing?

Ciclesonide

Which ICS is a pro drug and so can be used if patient is at risk of oral thrush?

Ciclesonide

What is step 1 for asthma control in children?

Low dose ICS | LTRA if < 5

What is step 2 for asthma management in children?

Very low dose ICS LABA if > 5 LTRA if < 5

What is step 3 part one for asthma management in children?

No response to LABA then stop and increase ICS to low dose

What is step 3 part two of asthma management in children?

If benefit from LABA but control still inadequate then continue LABA and increase ICS to low dose

What is step 3 part 3 for asthma management in children?

If benefit from LABA but control still inadequate continue LABA and ICS and consider trial of LTRA

What is step 4 for the asthma management in children?

Medium dose ICS Add fourth drug e.g. SR theophylline

What is step 5 for asthma management in children?

Oral steroid Maintain medium dose ICS

What are the very low dose ICS inhalers used in children?

Beclometasone - 200mcg Budesonide - 200 mcg Fluticasone - 100 mcg

What are the medium dose ICS inhalers used in children?

Beclometasone - 400-900 mcg Budesonide - 800 mcg Fluticasone - 500 mcg Ciclesonide - 320 mcg

What are the LTRAs used in children?

Montelukast Zafirlukast

What are the LABAs used in children?

Vilanterol Formoterol Salbmeterol

What are the oral steroids used in children for asthma?

Prednisolone

What are the low dose ICS used in adults for asthma?

Beclometasone - 100-400 mcg Budesonide - 400 mcg Fluticasone - 200-400 mcg Mometasone - 400 mcg Ciclesonide - 180 mcg

What are the high dose ICS used in asthma for adults?

Beclometasone - 800-2000 mcg Budesonide 1800 mcg Fluticasone - 1000 mcg

What are the LAMAs used in asthma for adults?

Tiotropium bromide

How long does ICS need to be used for to have an effect on the prevention of asthma?

Must take regularly for 3-4 weeks

Which inhalers do you need to prescribe by brand name?

Beclometasone Qvar and clenil are not interchangeable Qvar is twice as potent as clenil as has extra fine particles Fostair is even more potent than Qvar

What age are the beclometasone easyhalers licensed in?

18+

What age are the qvar inhalers licensed in?

12+

What are the side effects of ICS?

Hoarse throat Sore throat Oral candidiasis Paradoxical bronchospasm

How do you prevent oral thrush with ICS?

Rinse mouth and brush teeth after using Treat with daktarin gel

Who should you use a large volume spacer for?

High dose ICS Patients under 15

What do you do if paradoxical bronchospasm occurs with ICS?

Stop and give alternative Mild bronchospasm - use SABA before or transfer from pMDI to dry powder inhaler

Which inhalers should be refrigerated?

Trimbow Fostair

Does smoking reduce or increase effectiveness of ICS?

Reduces effectiveness Patient may need higher dose

What is the mechanism of action of leukotriene receptor antagonists?

Blocks action of leukotriene on the cysteinyl leukotriene receptor in the lungs and bronchi Reduces bronchoconstriction and inflammation

What are montelukast and zafirlukast used for?

Chronic asthma Symptomatic relief of hay fever in asthma

What are the side effects of the LTRAs?

Churg Strauss syndrome - occurs on withdrawal or reduction of ICS Zafirlukast - liver toxicity

What are the counselling points for zafirlukast?

Report signs of liver toxicity

What is theophylline?

Xanthine bronchodilator

Is aminophylline given IM or IV?

20x more soluble and too irritant to give IM

What is the range for theophylline?

10-20 mg/L Sample 4-6 hours after dose

What increases the Cp of theophylline?

``` Heart failure Hepatic impairment Viral infections Elderly Enzyme inhibitor ```

What decreases the Cp of theophylline?

Smoking Alcohol Enzyme inducers

Does theophylline need to be prescribed by brand?

Yes

What are the toxicity signs of theophylline?

Vomiting and GI Tachycardia, CNS stimulation Arrhythmias, convulsions, hypokalaemia Fast and sick

What are the interactions that cause an increased risk of hypokalaemia when used with theophylline?

Loop/thiazide diuretics Corticosteroids B2 agonists

What are the interactions that cause an increased risk of convulsions when used with theophylline?

Ciprofloxacin Quinolones are enzyme inhibitors and they lower seizure threshold

What are the interactions that cause an increased plasma concentration and risk of toxicity when used with theophylline?

``` Verapamil CCB Cimetidine Phenytoin Fluconazole Macrolides ```

What are the interactions that cause a reduced plasma concentration when used with theophylline?

St Johns Wort Rifampicin

Is an acute asthma attack an emergency?

Yes Failure to respond requires transfer to hospital

How do you treat acute asthma?

Salbutamol aerosol inhaler 2-10 puffs every 10-20 mins PRN OR Salbutamol/terbutaline nebuliser every 20-30 mins or PRN If symptoms persist after 15-30 mins - 999 Repeat above and add nebulised ipratropium bromide

What do you give in all cases of acute asthma?

Prednisolone tablets or IV hydrocortisone Children < 12 - up to 3 days Adult - at least 5 days (40-50mg OD)

Asthma Flashcards

(75 cards)