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RESP - 1 > Asthma Management > Flashcards

Asthma Management Flashcards

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1
Q

What drugs should be avoided in asthmatics?

A 
Beta blockers
NSAIDs
Aspirin
Sedatives
Strong opiates
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2
Q

Why is a MDI + spacer better than an MDI alone?

A

Low oropharyngeal deposition
Reduced bad taste
Reduced candidiasis
Reduced cold-freon effect in some

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3
Q

What are the aims of management in asthma?

A 
No day time symptoms
No night awakening due to asthma 
No need for rescue meds
No asthma attacks
No limitations on physical activity
Minimal SEs from treatment
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4
Q

Asthma treatment in adults:

STEP 1 - newly diagnosed asthma

A

SABA

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5
Q

Asthma treatment in adults:

STEP 2

A

Not controlled on prev step or newly diagnosed asthma with symptoms >=3/week or night time waking

SABA + low dose ICS

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6
Q

Asthma treatment in adults:

STEP 3

A

SABA + low dose ICS + LTRA

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7
Q

Asthma treatment in adults:

STEP 4

A

SABA + low dose ICS + LABA

Continue LTRA depending on response to LTRA

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8
Q

Asthma treatment in adults:

STEP 5

A

SABA +/- LTRA

Switch ICS/LABA for maintence and reliever therapy (MART) that includes low dose ICS

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9
Q

Asthma treatment in adults:

STEP 6

A

SABA +/- LTRA + medium dose ICS MART

Or consider changing back to fixed dose of moderate dose ICS and separate LABA

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10
Q

Asthma treatment in adults:

STEP 7

A

SABA +/- LTRA + 1 of:

  • Increase ICS to high dose (fixed dose regimen)
  • Trial of additional drug, e.g. LAMA or theophylline
  • Seek advice from healthcare professional with expertise in asthma
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11
Q

What is MART?

A

Maintenance and reliever therapy - form of combined ICS and fasting acting LABA used for maintenance and as needed as a reliever

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12
Q

What is considered low dose ICS in adults?

A

<=400mcg budesonide or equivalent

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13
Q

What is considered moderate dose ICS in adults?

A

400-800mcg budesonide or equivalent

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14
Q

What is considered high dose ICS in adults?

A

> 800 mcg or equivalent

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15
Q

What are e.g.s of SABAs?

A

Salbutamol (MDI)

Terbutaline (PDI)

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16
Q

What AEs are associated with SABAs?

A

Tremor, cramp, headache, flushing, palpitations, angina

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17
Q

Give e.g.s of ICSs

A

Bedomethasone
Budesonide
Flucticasone

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18
Q

What are AEs associated with ICS?

A

Dysphonia

Oesophageal candidiasis

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19
Q

Give e.g.s of LABAs

A

Formeterol

Salmeterol

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20
Q

What are the two LTRAs?

A

Montelukast or zarfirlukast

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21
Q

Who are LTRAs most effective in?

A

Those who are highly allergic

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22
Q

What is theophylline?

A

Non-specific phosphodiesterase inhibitor and adenosine receptor antagonist

It is a weak bronchodilator

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23
Q

What are SEs of theophylline?

A 
Anorexia
Headache
NV
Malaise
Nervousness
Ab discomfort
Insomnia
Tachycardia
Tachyarrhythmia 
Convulsions

NARROW THERAPEUTIC INDEX

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24
Q

Give an e.g. of a LAMA

Study These Flashcards
A

Tiotropium bromide

25
How do LAMAs help in asthma management?
Antagonist M3 muscarinic ACh receptor in bronchial smooth muscle
26
What SEs are associated with LAMAs?
Dry mouth GI upset Headaches Rarely angle closure glaucoma
27
If a patient with asthma has to go on long term oral steroids what steroid is usually used?
Prednisolone at lowest possible dose
28
What other drugs may be started by specialists to treat treatment resistant asthma?
Omalizumab Mepolizumab Immunosupressives, e.g. methotrexate, cyclosporin (last resort)
29
What is omalizumab?
Monoclonal Ab against IgE
30
What is mepolizumab?
Monoclonal Ab against IL-5 Given to those with poor asthma control with eosinophilia
31
What may be involved in the non-pharmacological management of asthma?
``` Advice re inhaler use Smoking cessation Flu/pneum vaccine Co-morbs Allergen avoidance ```
32
How is acute asthma (mild-moderate) treated in adults?
Oral prednisolone 7 day | Use SABA up to 2hrly
33
How is a severe acute asthma attack managed in adults?
``` Admit Oral/IV steroids Neb bronchodilators (salbutamol/ipatropium) Oxygen Consider ABG IV MgSO4 if no response Antibiotics if req. Lifethreatening --> ITU (may need intubation, ventilation, ECCO2R may be lifesaving) ```
34
What mnemonic is used to measure control of asthma in children?
``` SANE SABA/wk Absence from school/nursery Nocturnal symptoms/wk Exertional symptoms/wk ```
35
Asthma management in those aged 5-16 years: | STEP 1 - newly diagnosed asthma
SABA
36
Asthma management in those aged 5-16 years: | STEP 2
Not controlled on prev step/newly diagnosed asthma with symptoms >=3x/wk or night time waking SABA + paediatric low dose ICS
37
Asthma management in those aged 5-16 years: | STEP 3
SABA + paediatric low dose ICS + LTRA
38
Asthma management in those aged 5-16 years: | STEP 4
SABA + paediatric low dose ICS + LABA STOP LTRA if it has not helped
39
Asthma management in those aged 5-16 years: | STEP 5
SABA + switch ICS/LABA for maintenance + reliever therapy (MART) that includes low dose paediatric ICS
40
Asthma management in those aged 5-16 years: | STEP 6
SABA + paediatric moderate dose ICS MART OR consider changing back to fixed dose of a moderate dose ICS and separate LABA
41
Asthma management in those aged 5-16 years: | STEP 7
SABA + 1 of: - Increase ICS to paediatric high dose (either as part of fixed dose regimen or MART) - Trial additional drug, e.g. theophylline - Seek advice
42
Asthma management in those aged <5 years: | STEP 1
SABA
43
Asthma management in those aged <5 years: | STEP 2
SABA + 8 week trial of paediatric moderate dose ICS After 8w stop + monitor child's symptoms - if did not resolve during trial review + consider alt diagnosis, if symptoms resolved then reoccur within 4 weeks restart ICS at paediatric low dose as first line maintenance therapy, if symptoms resolved but reoccured beyond 4 weeks of stopping ICS, repeat 8 week trial of paediatric moderate dose ICS
44
Asthma management in those aged <5 years: | STEP 3
SABA + low dose ICs + LTRA
45
Asthma management in those aged <5 years: | STEP 4
Stop LTRA and refer to paediatric asthma specialist
46
What is considered paediatric low dose ICS?
<=200mcg budesonide or equivalent
47
What is considered paediatric moderate dose ICS?
200-400mcg budesonide or equivalent
48
What is considered paediatric high dose ICS?
>400 budesonide or equivalent
49
What advice can you give to parents about what they can possibly do to improve their child's asthma?
Stop tobacco exposure | Remove environmental triggers
50
What patients with acute asthma should have an ABG?
Those with O2 sats <92%
51
When might you do a CXR in acute asthma?
Life-threatening asthma Suspected pneumothorax Failure to respond to treatment
52
What patients should be admitted to hospital if they are having an acute asthma attack (adults)?
``` Life-threatening/severe features Prev. near fatal asthma attack Failure to respond to initial treatment Pregnant An attack occurring despite already being on oral corticosteroids ```
53
What oxygen should those admitted with an asthma attack be given?
15L supplemental via non-rebreathe mask (can be titrated down when they are able to maintain an SpO2 of 94-98%)
54
How should SABA be given in acute asthma?
If mild/moderate - pMDI/oxygen driven nebuliser | Life-threatening/severe - nebulised
55
What corticosteroid and what dose of it should be given to adults having acute asthma?
40-50mg prednisolone PO for at least 5 days
56
What additional drugs may be given to those with severe/life-threatning asthma?
Ipratropium bromide IV magnesium sulphate IV aminophylline If fail to respond to this --> ITU for intubation, ventilation and possibly ECMO
57
What is the criteria for discharge of adults with acute asthma?
Stable on discharge meds for 12-24h Inhaler technique checked and recorded PEF >75% best/predicted
58
How is mild-moderate acute asthma in children managed?
Bronchilator therapy - SABA (one puff every 30-60s up to max of 10 puffs) --> if symptoms not controlled send to hospital Steroids - 3-5 days (pred 1-2mg/kg od)

RESP - 1 (27 decks)

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