Management Of Asthma Flashcards
What is self effective management in Asthma
** Self management is key to success in therapy**
5 main points
1.) adherence to treatment plan
2.) Correct use of in haler technique
3.) Having an up to date asthma management plan
4.) Managing and avoiding triggers
5.) Monitoring asthma control( symptoms)
What are the risk factors to asthma exacerbations
1.) history of 1> exacerbation in a year.
2.) poor adherence.
3.) INcorrect inhaler technique
4.) smoking
What is good asthma control
- NO daytime symtoms (<2 in a week)
- NO limitations on daily activities ( exercise )
- NO night time symtoms ( coughing at night, difficulty sleeping)
- NO need for reliever treatment > 2 times a week
- NO exacerbations
Describe reasons for poor asthma control
Things it can be due to
>medication related issues-
- incorrect inhaler technique.
-incorrect preventer dose.
-Over reliance on reliever.
-Poor adherence to preventer
-Medication interaction
>Limited knowledge of asthma and poor ability to self manage - make sure patient is involved in care plan
> NO asthma action plan or regular medical review
What is the asthma step up management plan
Consider using LABA with ICS not alone increased risk of mortality
Before stepping up- check and fix adherence, inhaler technique
When to step in treatment - poor asthma control, using SABA more than 2 a week and if not using an ICS
When should you step down in treatment
Patient is advised to step down if asthma control has been good for 2-3 months.
Review asthma 4-8 weeks after step down- previous dose may be resumed if control deteriorates
WHAt is the S.M.A.R.T therapy
Symbiont Maintenance and Reliever Therapy
- Budesonide and fometerol combination used as a preventer and a reliever
Symbicort turbuhailer -(100/6, 200/6)
Symbicort rapihaler-(50/3 and 100/6)
» only switch strength with devices «_space;
Respimat (pMDI) may be preferred over DPI(Turbuhaler )for patients who have difficulty taking in a deep breath for dose actuation
What are they doses with SMART therapy
12years and over
Maintenance therapy( used daily)
pMDI- 4 puffs daily in 1-2 divided doses
DPI - 2 puffs twice daily
Symptom relief
pMDI- 2 inhalations when required repeated every few minutes up to 12inhalations at any one time 24 inhalations MAX DAILY
DPI- 1 puff when required repeated every few minutes with 6 puffs at any one time and 12 MAX daily
How do you differentiate between an Acute Flare up and an asthma attack in adults
- A flare up is when patient is reporting of having difficulty with daily activity and having to use reliever within 3 hours.
- Attack is sudden and patient is wheezing , tugging at chest finding difficulty breathing
Flare up Protocol
Oral corticosteroid 37.5mg-50mg ONCE daily for 7-10days
Attack Protocol
4 puffs with 4 breaths in between repeated in 4 minutes
How is asthma control defined in children
Generally, if child displays
- difficulty with doing day time activity’s more than 2 times a week
- symptom’s at night or when waking up (coughing)
Use of a SABA more than 2 times a week ( 3 or more )
What is asthma managed in children 1-5 years
IN childeren of this age asthma diagnosis can not be confirmed via spirometry
Patient is trialled on salbutamol as reliever via spacer.
Preventer not recommended unless under specialist
Start SABA prn-
> INCREASE low dose ICS( low )daily+ Montelukast+SABA
>INCREASE SABA+ ICS (high)+Montelukast+ SABA
- low dose ICS can be given
- if patients parents don’t want to use inhaler or compliance issues then can give montelukast at 4mg once daily
How is asthma managed in kids 6>
When do you step up management in kids >6years
If asthma remains uncontrolled despite maximum regular preventer usage.
First
- check inhalers compliance
- check technique
- Check dose.
Considerations.
- if on montelukast- stop abruptly and start on ICS low dose
- if on ICS- add montelukast
- increase dose of ICS.
- Switch to ICS/LABA
When do you step down in treatment with kids 6>
Can be considered when asthma is being well controlled for 6 months
Increased risk of flare up when stepping down hence close monitoring required.
If child on low dose ICS+ Montelukast can cease ICS and child stays on MOntelukast
If child on ICS+LABA- Can reduce ICS dose or Use ICS only
Which inhalers are preferred in children
Tidal breathing technique can be used in children( 1 puff Plus 4-6 breaths)
MDI plus spacer recommended in kids
DPI not appropriate as kids can’t take a a big deep breath
