Asthma Flashcards
What is Asthma
Chronic inflammation of the airways, usually allergic in origin.
Characterised by:
Hyper reactive airways
Bronchoconstriction in response to triggers
Reversibility of the airway obstruction
How do you make diagnosis in children
Chronic persistent cough and/or wheeze
Responds to Bronchodilator
Symptoms and signs of asthma
Cough
Wheeze
Dyspnoea
Tight chest
Variability of symptoms
Precipitated by range of factors
What is COPD
Abnormal inflammatory response by lungs to irritants
• Resultant, partially reversible, progressive airflow limitation
How do you diagnose COPD (What does the patient present with)
Chronic progressive dyspnoea and or chronic cough (productive or not) with smoking history of more than 10 pack years and/or other risk factors of COPD
What is an asthma reliever and what’s a reliever?
• Reliever
short-acting bronchodilators with rapid onset of action providing acute symptomatic
relief. E.g Salbutamol, Fenoterol, Terbutaline
• Controllers
drugs with anti-inflammatory and/or a sustained bronchodilator action. Eg inhaled corticosteroids such as Beclomethasone and Long acting beta2 agonists such as Salmeterol, Formoterol.
How do you manage chronic asthma
Spacer device
• All patients get reliever- salbutamol
• Check inhaler technique
• Start beclomethasone 200mcg 12 hourly
• If not controlled increase dose to beclomethasone 400mcg 12 hourly
• If still not controlled, add LABA eg switch to salmeterol + fluticasone
50/250 1 puff 12 hrly
• If still not controlled, referral to specialist:
• (leukotriene receptor antagonist, tiotropium bromide, theophylline)
How do you assess for asthma control in patients
Day time
Nocturnal symptoms
Need for reliever
Exacerbations
Interfering with daily functioning
Lung function (PEV)
Side effects of Inhaled corticosteroids
oropharyngeal candidiasis & hoarseness
Side effects of long acting beta agonists
May cause tremors and palpitations
When do you use Leukotriene receptor antagonists for asthma
Not effective as mono therapy,
Useful on Add on therapy when still symptomatic despite already on corticosteroids and long acting beta 2 agonist or pt can’t tolerate Beta2 agonist.
Withdraw if no improvements after 4 weeks
Very few side effects
Uses of Theophylline in asthma control
Only used as add on therapy
MOA: non selective inhibition of phosphodiesterades
Narrow therapeutic index
Side effects:
gastro (nausea and vomiting)
Cardiac arrhythmias
CNS: tremors, confusion, seizures
Oral corticosteroids as asthma control
Short course after acute exacerbation
• Severe and poorly-controlled asthma
• Risk of significant side effects: Suppress HPA axis-adrenal atrophy and
inadequate stress response. Hypertension, fluid and electrolyte
disturbances, hyperglycaemia, inhibits inflammatory response, peptic
ulcer disease, muscle weakness, cataracts, osteoporosis, osteonecrosis,
growth retardation, Cushing’s syndrome, diabetogenic, dyslipidaemia.
Psychiatric-euphoria, behavioral changes, depression.
How would you manage acute severe asthma
• Oxygen by face mask
• Beta2-agonist by MDI with spacer/nebuliser
• Early systemic corticosteroids: oral prednisone or IV corticosteroids
• Ipratropium bromide if response to salbutamol poor
• IV magnesium sulphate
• Intubation and ventilation
• Do NOT use intravenous aminophylline- increased adverse effects (vomiting
and dysrhythmias), does not improve bronchodilation and outcome
• Intravenous beta2 stimulants- adverse effects
Which drugs should be avoided if you have asthma
Beta blockers
NSAIDS
Aspirin
