Asthma Flashcards
(24 cards)
What is a moderate acute asthma attack?
- Peak Flow
- Speech
Peak flow: >50%
Speech: Normal
What is a Severe acute asthma attack?
- Peak Flow
- Speech
- SpO2
Peak Flow: 33-50%
Speech: Unable to complete full sentences
SpO2: >92%
What is a Life Threatening acute asthma attack?
- Peak Flow
- SpO2
- Other symptoms
Peak flow: <33%
SpO2: <92%
Other Symptoms:
- altered consciousness
- arrhythmias
- Hypotension
- Cyanosis
What is the management of a MODERATE acute asthma attack
- Adult
- Children
SABA- through large volume SPACER
- Up to 10 puffs
Adult: 4 puffs initially, then 2 puffs every 2 minutes
- oral prednisolone: 40-50mg for 5 days
Children: 1 puff every 30-60 seconds
What is the dose of prednisolone given in an acute asthma attack compared to an exacerbation of COPD?
Asthma: 40-50mg for 5 days (in 12 years plus)
COPD: 30mg for 5 days
When should someone having a moderate acute asthma attack be admitted to hospital?
- under 18
- pregnant
- previous severe asthma attack
- inadequate treatment response
What is the management for SEVERE or LIFE-THREATENING acute asthma attack
- Adults
- Children
High dose SALBUTAMOL via a NEBULISER
- 5mg in >5 years
- 2.5mg in 2-5 years
+ nebulised ipratropium (SAMA)
+ IV magnesium or aminophylline
Oral PREDNISOLONE
- adult: 40-50mg for 5 days
- children >5 years: 30-40mg for 3 days
- children 2-5 years: 20mg for 3 days
- children <2 years: 10mg for 3 days
What can be used instead of prednisolone in the management of severe acute asthma attack?
- e.g. if they have altered consciousness and cant have oral pred
Methylpednisolone
IV hydrocortisone
Lifestyle changes for chronic asthma
- weight loss (if over weight)
- smoking cessation
- breathing exercises
- identifying triggers
- keeping warm and dry in cold weather
Chronic asthma management in 12 years+
- 4 steps
Step 1: Low dose ICS + formerterol (LABA) PRN
- AIR therpay
Step 2: AIR therapy as maintenance and reliever therapy (MART)
Step 3: Increase dose of MART therapy
Step 4: Test FeNO (fractional exhaled nitric oxide) and eosinophil count
Which two drugs are used in AIR therapy?
- licensed as of 2024
Fomoterol (LABA) and budesonide (ICS)
When should someone step up from AIR therapy?
- what should they be switched to?
If they need the reliever more than 3+ days per week
OR
Having 1+ nights per week of night-time waking
- Switch to low dose MART therapy
- moderate dose MART therapy if still not controlled
What to do if FeNO levels OR eosinophil count is raised? (Step 4 management)
Refer to specialist
What to do if FeNO levels OR eosinophil count is normal? (Step 4 management)
- two options
Add either
- Leukotriene receptor antagonist (LTRA like montelukast)
- LAMA
How long are LTRA or LAMAs trialed for?
- controlled?
- improved but inadequate?
- not improved?
Trailed for 8-12 weeks
- Controlled: continue
- improved but not adequate: add other (LAMA or LTRA)
- NOT improved: Stop either LTRA or LAMA and trial other
- No Improvement -> specialist
When to switch someone from old to new asthma management guidelines
Only swap patients over if they are not controlled
Switching someone from old to new guidelines if on:
- SABA alone
- Low dose ICS with SABA/LABA/LTRA
- Moderate ICS with SABA/LABA/LTRA
- High dose ICS
SABA alone -> AIR as needed
Low dose ICS with SABA/LABA/LTRA -> low-dose MART
Moderate ICS with SABA/LABA/LTRA -> Moderate dose MART
High dose ICS -> Specialist
Chronic asthma management in 5-11 years+
- 4 steps
Step 1: SABA + paeds low dose ICS
- SABA PRN, ICS BD
Step 2: LABA (formoterol) + ICS as MART
- use BD ICS/LABA + SABA PRN if MART not manageable
Step 3: Add LTRA
- same 8-12 week trial
Chronic asthma management in under 5 years
Step 1: SABA plus paeds low-dose ICS
- SABA PRN, ICS BD trial for 8-12 weeks
- assess symptoms after trail
What to do if symptoms DO NOT resolve in 8-12 trial period of SABA + ICS for those under 5 in management of chronic asthma
- check inhaler technique, adherence, environmental factors (e.g. smoke, damp or allergy) and alternative diagnosis
- if non explain -> refer to specialist
What to do if symptoms DO resolve in 8-12 trial period of SABA + ICS for those under 5 in management of chronic asthma?
Consider stopping and review in 3 months
If child has had acute episode after stopping
- Restart ICS + SABA (start on low dose and titrate up)
- Add LTRA (with 8-12 week trail)
when should someone being treated for chronic asthma be dropped down a step in management?
Asthma that has been controlled for at least 3 months
what should the dose of ICS be reduced by ?
Reduced every 3 months by 25-50% each time
What is complete asthma control?
- no daytime symptoms
- no night time waking due to asthma
- no asthma attacks
- no need for rescue meds
- no exercise limitation due to asthma
- normal lung function
- minimal side effects
