ASTHMA DIAGNOSIS AND MANAGEMENT Flashcards
(54 cards)
1st line treatment for asthma >12 years newly diagnoses
low dose ICS/formoterol inhaler (eg. Symbicort®, Fostair®, DuoResp®, Fobumix®, Luforbec®, and Wockair) as AIR therapy - as required
If asthma uncontrolled after 1st line in >12 years? what’s the next line therapy
Low dose ICS/formoterol (eg.Symbicort®, Fostair®, DuoResp®, Fobumix®, Luforbec®, and Wockair) as MART therapy - prescribed intervals
If asthma uncontrolled after 2nd line in >12 years? what’s the next line therapy
Moderate ICS/formeterol (eg.ISymbicort®, Fostair®, DuoResp®, Fobumix®, Luforbec®, and Wockair) as MART therapy
If asthma uncontrolled after 3rd line in >12 years? what’s the next line therapy
Check FeNO levels and blood eosinophil count (specialist referral). If either of these are raised try LTRA or LAMA in addition to MART therapy for 8-12 weeks. if still uncontrolled refer to specialist
define uncontrolled asthma
exacerbation needing ICS or frequent regular symptoms eg. reliever inhaler > 3 days a week or at night, waking > 1 times in a week
Moving patients from current treatment to new treatment?
SABA only - ICS/formoterol AIR therapy whether asthma controlled or not
If asthma uncontolled and ..
Low dose ICS any combination of therapies = Low dose MART therapy
Moderate dose ICS combination = Moderate dose MART therapy
1st line treatment for asthma 5-11 years newly diagnoses
BD paeds low dose ICS/SABA when required
managing asthma for those who MART therapy is appropriate
Paeds low dose MART (off label)
Dose can be increased to moderate paeds if asthma uncontrolled
Then refer to specialist
managing asthma for those who MART therapy is NOT appropriate
try LTRA eg. monteleukast added to BD low dose ICS 8-12 weeks
if still unmanaged offer paeds low dose ICS/LABA +/- LTRA when required
If still uncontrolled all 3 but moderate
refer to specialist if still uncontrolled
1st line treatment for asthma <5 years newly diagnoses
Low dose paeds ICS + SABA when required trial for 8-12 weeks
1st line treatment for asthma <5 years newly diagnoses fails. What happens next?
check adherence / inhaler technique, environmental factors, alternative digonisis then refer if symptoms dont resolve
OR
if symptooms resolve - stop ICS + SABA and if symptoms come back build back up ICS low - moderate dose, then LTRA, then refer if needed
Asthma diagnosis >16 years
Get clinical history - symptoms, triggers, family history
Objective tests:
1. Eosinophils / FeNo test: >50ppm
2. Spirometry: FEV1 increase is 12% or more from baseline (or if the FEV1 increase is 10% or more of the predicted normal FEV
3. Peak flow BD for 2 weeks: PEF veriabilit >20%
4. Bronchial challenge (secondary care)
Asthma diagnosis 5-11 years
Get clinical history - symptoms, triggers, family history
Objective tests:
1. Eosinophils / FeNo test: >35ppm
2. Spirometry: FEV1 increase is 12% or more from baseline (or if the FEV1 increase is 10% or more of the predicted normal FEV
3. Peak flow BD for 2 weeks: PEF veriabilit >20%
4. Bronchial challenge (secondary care)
Asthma diagnosis <5 years
try with ICS and review
When patient gets to 5 years, perform objective tests
Symptoms of asthma
SOB
Coughing
Wheezing
tight chest
ICS dosages for >12 years
Low dose Beclomethasone - standard particle meter dose / dry powder
200 - 500mcg per day in 2 doses
ICS dosages for >12 years
moderate dose Beclomethasone - standard particle meter dose / dry powder
600-800 mcg per day in 2 doses
ICS dosages for >12 years
high dose Beclomethasone - standard particle meter dose / dry powder
1,000-2,000mcg per day in 2 doses
ICS dosages for >12 years
low dose betamethasone of extra fine particles
100-200mcg per day in 2 doses
ICS dosages for >12 years
moderate dose betamethasone of extra fine particles
300-400mcg per day in 2 doses
ICS dosages for >12 years
high dose betamethasone of extra fine particles
500-800mcg per day in 2 doses
examples of betamethasone extra fine particles brands
Qvar, Luforbec, Kelhale and Fostair
These are more potent than standard ICS particle size
ICS dosages for >12 years
low dose budesonide
200-400mcg per day in 1-2 doses
ICS dosages for >12 years
moderate dose budesonide
600-800mcg per day in 1-2 doses
