Asthma Flashcards
What is the first line therapy for newly diagnosed asthma in over 12s?
Air therapy: Combination Low dose inhaled corticosteroid (anti-inflammation)
Formoterol
-> immediate symptom relief
Should be PRN as needed
What is second line therapy for new asthma diagnosis?
MART inhaler with MODERATE inhaled corticosteroid and LABA like formoterol
What is third line therapy for asthma?
MART inhaler with MODERATE inhaled corticosteroid with LABA like formoterol for
What should be done 4th line if asthma is still not controlled?
Check FeNO and blood eosinophil count and if raised, refers o specialist asthma service
What to do 4th line if FeNO or blood eosinophil are not raised?
Moderate-dose MART with Addition of leukotriene receptor antagonist like montelukuast tablet every night
Long acting muscarinic agonist like tiotropium
What are the signs of poorly controlled asthma?
signs include:
Tachypnoea
Increased work of breathing
Hyperinflated chest
Expiratory polyphonic wheeze throughout the lung fields
Decreased air entry (if severe)
What are triggers for asthma exacerbation?
Cold air and exercise
Pollution and cigarette smoke
Allergens such as animal dander, dust mites and pollen
Irritants such as perfumes, paints or air fresheners
Medications such as NSAIDs or beta-blockers
Which test is sufficient enough to confirm asthma?
Clinical history with blood eosinophil level OR FeNO level
Which test should be done if FeNO and blood eosinophil are inconclusive?
Bronchial challenge
What is considered uncontrolled asthma?
Patient has an exacerbation requiring oral corticosteroids, so move to next INR of management
What is the criteria for discharge after asthma attack?
Stable on regular salbutamol inhaler for 24 hours
PEFR above 75%
What is the PEFR value for discharge?
75%
When are oral corticosteroids used in asthma?
Acute severe exacerbation
Maintenance therapy in very poorly controlled asthma unresponsive to add-on therapies
What is the next step for asthma not controlled by moderate dose MART?
Moderate dose MART includes LABA and moderate dose ICS.
Addition of LAMA should be done.
What is the best test for asthma when FeNO levels or eosinophil count are insufficient?
Bronchodilator reversibility testing which is an objective test recommended by NICE, if patient symptoms are not in severe exacerbationn
What is the first line therapy for patients with severe exacerbation of asthma at diagnosis?
Begin with MART rather than AIR because this indicates uncontrolled asthma
What is the difference between AIR and MART?
AIR is as needed either LABA or ICS
MART is combination LABA and ICS
What are the hisotlogical findings in asthma?
Curschmann spirals, where shed epithelium becomes whorled mucous plugs
What PEFR indicates acute severe asthma?
PEFR 33-50%
What PEFR value indicates life threatening asthma?
Less than 33% PEFR
What is a CO2 indicator for life threatening asthma? n
Normal CO2 as the patient tires from hyperventilation to become normocapnci
