Asthma Flashcards
(26 cards)
Step 1: Mild intermittent asthma (Newly diagnosed)
1st- As-needed AIR therapy (low dose ICS/Formoterol combo inhaler)
Alternative- If not suitable, SABA as needed
If highly symptomatic/severe exacerbation- Start with low dose MART and consider oral corticosteroids
Step 2: Regular preventer therapy
1st- Low dose MART (ICS/Formoterol as MART)
Alternative: Daily low dose ICS plus as needed SABA (if not using MART)
Step 3: Initial add on therapy
If asthma is uncontrolled on low dose MART:
- Increase to moderate dose MART
- If FeNO/esoniophils are raised refer to specialist. If normal, trial either LTRA or LAMA for 8-12 weeks
Step 4: Persistent poor control
If moderate MART ineffective -> try the alternative add on therapy (LTRA or LAMA)
If control remains inadequate, stop ineffective treatments and refer to specialist
Step 5: Severe or uncontrolled asthma
High dose ICS with LABA in MART or fixed dose regimen
Consider biologics for eosniophillic or allergic asthma
Oral corticosteroids use at the lowest effective dose
Switching from old treatment pathways
- Change SABA only users to as-needed AIR therapy
- Switch low dose ICS users to low dose MART if uncontrolled
- Switch moderate dose ICS users to moderate dose MART if needed
- Refer to a specialist if high dose ICS does not achieve control
SABA cautions
Hypokalaemia
Increased risk of severe asthma when given with theophylline, corticosteroids, diuretics
SABA monitoring
Potassium levels
Blood glucose in diabetics
SABA interactions
Increased risk with digoxin toxicity
Increased hypokalaemia risk with erythromycin, escitalopram and fluconazole
Corticosteroids examples
Beclometasone
Fluticasone
Ciclesonide
Budesonide
Mometasone
MHRA advice for corticosteroids
Central serous chorioretinopathy can occur with all
routes of corticosteroids. Patients should be advised to
report any visual disturbances that occur.
Spacer advice
-Helps minimise oral thrush
-Cleaned every month with mild detergent and water and allowed to air dry
- Check mouthpiece is clean of detergent before using and should inhale from spacer as soon as possible
- Device should be replaced every 6-12 months
Corticosteroid monitoring in children
Annually weight and height of children
MHRA advice for beclometasone
QVAR and clenil are not interchangeable due to the extra fine particles in QVAR being more potent
MHRA advice for FOSTAIR
Fostair has extra fine particles and is more potent than traditional beclometasone inhalers. Therefore the dose in fostair should be lower.
Corticosteorids Interactions
Amiodarone: Increased hypokalaemia risk
Erythromycin: Increased hypokalaemia risk
Naproxen: Increased risk of GI bleeding
LABA examples
Salmeterol, Formoterol
Important info- LABA
- only to be added when ICS not controlling
- Not for asthma that is deteriorating
- Not to be used for exercise induced asthma unless ICS is used alongside
- Discontinue if no benefit
- stepping down treatment when control is achieved
LABA interactions
Digoxin: Increased risk of toxicity
Increased hypokalaemia risk with erythromycin, escitalopram and fluconazole
Examples of LABA in combination inhaler with an ICS (As part of MART)
Fostair
Symbicort
LTRA example
Montelukast
When should montelukast be taken
At night
MHRA advice on montelukast
Neuropsychiatric symptoms such as speech
impairment and obsessive compulsive symptoms.
Patients should read the patient information leaflet
and seek immediate medical advice if this occurs
Antimuscaranics examples
Tiotropium (Braltus, Spiriva Respimat)- LAMA
Ipratropium
(Atrovent)- SAMA
