adult asthma management

Question 1

what would happen if asthma was completely controlled

Answer 1

no daytime symptoms
no night-time awakening due to asthma 
no need for rescue medication
no asthma attacks 
no limitations on activity (inc exercise) and normal lung function (FEV1 and or PEF >80% predicted/best)
minimal side effects from medication

Question 2

non-pharmacological management

Answer 2

patient education and self-management plans
exercise
smoking and vaping cessation
weight management
flu/pneumococcal vaccinations
all patients should have an asthma action plan

Question 3

what is an asthma action plan

Answer 3

how to stay on top of their asthma
what happens when it gets worse
what to do when having an asthma attack

Question 4

pharmacological management

Answer 4

as much disease control w/ as little as possible to reduce side effects
inhalers
oral therapy
specialist options

Question 5

inhalers

Answer 5

small dose of drugs
delivered directly to the target organ 
faster onset of effect 
minimal systemic exposure therefore systemic adverse effects are less severe and less frequent 
PMDI
SABA
DPI

Question 6

PMDI

Answer 6

pressurised metered dose inhalers

can we used w/ spacers

Question 7

DPI

Answer 7

dry powder inhaler

Question 8

SABA

Answer 8

short acting beta2 agonist - relievers

salbutamol (MDI, DPI), terbutaline (DPI)

Question 9

oral therapy

Answer 9

leukotriene receptor antagonist
theophylline
prednisolone

Question 10

specialist options

Answer 10

omalizumab (anti IgE)
mepolizumab (anti-IL5)
bronchial thermoplasty

Question 11

acute asthma attack

Answer 11

patient specific, known trigger/history
avoid delays and reduce guidelines
determine severity of the attack

Question 12

mild - moderate asthma attack treatment

Answer 12

increase inhaler use
oral steroid
treat trigger
early follow up
back up plan

Question 13

moderate/severe asthma attack treatment

Answer 13

HOSPITAL 
nebulisers (salbutamol/ipratropium)
magnesium 
oral/IV steroid
aminophylline 
complications: CXR
triggers: infection/allergy
level 2/3 care (HDU/ITU)
review

Question 14

contrast w/ COPD

Answer 14

age of onset (usually in 50s, only younger if heavy smoker)
smoking Hx (not always, also quarry workers)
response to treatment
treatment goals
trajectory (airway narrowing isnt reversible in COPD)

Question 15

COPD vs asthma therapy

Answer 15

treatment goals are different 
similar therapies (open up airways, reduce inflammation, prevent infection)
same non-pharmacological interventions