asthma C6

Question 1

how should episodes of acute asthma be followed up?
ASTHMA ATTACK

Answer 1

review preventative therapy and inhaler technique, if applicable
written asthma action plan
inform GP within 24 hours of discharge for review within 2 days

Question 2

MOA LABA - salmeterol, formoterol

Answer 2

agonist at beta 2 adrenergic receptors
= relaxation of bronchial smooth muscle = increased airflow

irreversible binding - as opposed to SABA - where there is reversible binding

Question 3

MOA montelukast LTRA

Answer 3

Leukotrienes are released by cells such as eosinophils. These are inflammatory mediators that cause bronchoconstriction, mucous secrretion and recruitment of inflammatory cells

LTRAs bind to leukotriene recptors - specifically CysLT1 in lungs and airwats. Blocking the action of leukotriene D4

= bronchodilation, decreasedairway inflammation, decreased mucous secretion

Question 4

MOA salbutamol - SABA

Answer 4

activate beta 2 adrenergic receptors in airway smooth muscle = relaxation = bronchodilator

increase in cellular cAMP = activation of protein kinase A = inhibition of phosphorylation of myosin and lowers intracellular calcium = smooth muscle relaxation

short acting as reversible binding

Question 5

MOA ipratropium - SAMA

Answer 5

reverisble binding to muscarinic receptors - specifically M3

blocks Ach binding
- Ach release unto muscle cells causes smooth muscle contraction

blocking Ach = less contraction = airway dilation and relaxation

Question 6

MOA beclomethasone, fluticasone -ICS

Answer 6

prodrug

activated by hydrolysis

binds to glucocorticoid receptor (endogenous binding site of cortisol)
= receptor dimersiation
= receptors translocate into the nucleus
= changes in transcription = less production of inflammatory proteins such as interleukin 10

Question 7

counselling pMDI

Answer 7

first time using - administer spray into air
Breathe out away from inhaler
seal around the mouthpiece
press the canister if that is a part of the inhaler
brethe in slowly and deeply
hold for 10 or as long as you comfortably can
Breathe out gently
Repeat the second dose after a minute if required

clean weekly - cleaning instructions in PIL

Question 8

counselling DPI

Answer 8

check mouthpiece is clean and clear to use

insert capsule into inhaler device if appropriate or check enough doses left

breathe out and away from inhaler until lungs empty

seal around mouthpiece

breathe in deep and hard

hold or 10

dispose of empty capsule
if there is powder left in capsule repeat dose after a min if needed

clean weekly as per instructions

Question 9

counselling ICS

Answer 9

Rinse mouth out after use - prevention of oral thrush

use daily

Inhaler technique as per the inhaler

Consistency is key = will work if used daily

Question 10

spacer cleaning

Answer 10

warm soapy water
let air dry

Question 11

what should be taken into account with uncontrolled asthma before adjusting/starting medicines

Answer 11

alternative diagnosis
poor adherence
poor inhaler technique
smoking
seasonal/environmental factors

Question 12

what is MART

Answer 12

maintenance and reliever therapy
Combined ICS plus formoterol used for maintenance therapy and relief of symptoms as needed

Question 13

Should beclametasone be prescribed by brand, and why

Answer 13

yes
different formulations meaning different potencies and different methods of use

eg clenil vs QVAR

Question 14

Clenil vs QVAR

Answer 14

BECLOMETASONE

both pMDIs

not interchangeable

QVAR = extra fine particles, more poptent (2x as clenil)

Question 15

When is hydrocortisone or prednisolone given for asthma

Answer 15

acute exacerbation of asthma
IV administration

Question 16

When is nebulised ipratropium used?

Answer 16

acute exacerbation of asthma
reduced mucus secretions (unlike salbutamol SABA), improved delivery via neb (compared to salbutamol)