Asthma Flashcards
What is asthma?
a chronic inflammatory disease of the airways
Is inflammation caused by asthma irreversible?
Reversible
What are the common symptoms of asthma?
Shortness of breath, wheeze, dyspnoea
Asthma is often worse at night. True or false?
True
What are the aims of treatment of asthma?
minimise side effects, no need for rescue meds, control symptoms including nocturnal and exercise induced, prevent exacerbations, achieve best possible lung function
Give examples of non-pharmacological management of asthma
avoid exposure to allergens, stop smoking, breastfeeding – reduces chances of baby developing, reduce weight if obese, avoid NSAIDs and B blockers, Avoid exercise in cold air
What are SABAs? Give an example
SABAs are relievers and include salbutamol and terbutaline
What does ICS do? Give an example
They are preventers and include beclomethasone
What are LABAs? Give some examples
LABAs are controllers and include salmeterol and eformoterol
Is coordination needed for the use of nebulisers?
No
Formeterol is both a reliever and a controller. True or false?
True
What are some ADRs for B-agonists?
hypokalaemia, tremor, tachycardia, peripheral vasodilation
Is prednisolone an inhaled corticosteroid?
No oral
What is the route of admin for beclomethasone?
Inhalation
What is the route of admin for hydrocortisone?
IV
Under what conditions is an ICS used?
Exacerbation of asthma in last 2 years, Using inhaled B2 agonist more than 3 times a week, Symptomatic more than 3 times a week, Waking 1 night per week
Hoarseness is an ADR of oral corticosteroids. True or false?
No, inhaled
Osteoporosis is an ADR of oral corticosteroids. True or false?
True
Hyperglycaemia is an ADR of inhaled corticosteroids. True or false?
False, oral
Does use of B2 agonists cause hyperkalaemia or hypokalaemia?
hypokalaemia
Give two examples of leukotriene antagonists used in asthma treatment
Montelukast & Zafirlukast
Name 2 ADRs of leukotriene antagonists
Thirst, Rash, sleep disturbance
Which group of drugs does Theophylline belong to?
Methylxanthines
Is Theophylline administered IV?
No, oral
Do methylxanthines have a narrow therapeutic window and what is that range?
yes, 10-20mg/ml
What effect does smoking have on the clearance of methylxanthines?
It increases clearance and therefore reduces plasma levels of methylxanthines meaning an increased dose is needed for same therapeutic effect if patient smokes
What effect does obesity have on the clearance and plasma levels of methylxanthines?
reduces clearance and therefore increases plasma levels
Name a cromone used in the treatment of asthma
Nedocromil
Nedocromil is a preventer used in the treatment of which age group?
5-12 y/o
Which immunosuppressants are used in the treatment of asthma?
Methotrexate and ciclosporin
Omalizumab is a monoclonal antibody that is offered to all asthma patients. True or false?
False, patient has to meet specialist criteria
How is omalizumab administered?
S/C
PEF is independent of age, sex and height. True or false?
False, dependent
What four features determine if asthma is acute & severe?
PEF<50%, ability to talk, RR>25, HR>110
What indicates that asthma is life-threatening?
PEF<50%, RR>25, HR>110 PLUS: silent chest, bradycardia, confusion, difficulty speaking full sentences
Theophylline is a salt of aminophylline. True or false?
false, aminophylline is a salt of theophylline and can be administered orally/IV
What is the immediate treatment that is required for acute severe asthma?
oxygen at the highest possible conc: 40-60%, B-agonist nebuliser or multiple doses via spacer, Corticosteroid: 40mg prednisolone or 100mg hydrocortisone IV
What does step 1 BTS/SIGN guidelines for adults asthma state?
low dose ICS
What does step 2 BTS/SIGN guidelines for adults asthma state?
Add LABA to low dose ICS (usually a combination inhaler)
What does step 3 BTS/SIGN guidelines for adults asthma state?
Increase ICS to medium dose, continue LABA, consider trialing LTRA SR theophylline, LAMA
What does step 4 BTS/SIGN guidelines for adults asthma state?
Increase ICS to high dose and add a fourth drug: LTRA, SR theophylline, B agonist tablet, LAMA
What does step 5 BTS/SIGN guidelines for adults asthma state?
Continuous or frequent use of oral steroid. Consider other treatment to minimise use of steroid tablet
What is step 1 in BTS/SIGN child asthma?
Very low dose ICS or if child is under 5 LTRA
What does step 2 in BTS/SIGN child asthma state?
Very low dose ICS and if child is under 5 add: LTRA
What does step 3 in BTS/SIGN child asthma state?
If no response to LABA stop and increase ICS to low dose
Response to LABA, but inadequate - Cont LABA, increase ICS to low dose
Response to LABA, but inadequate, cont LABA and ICS, and consider LTRA
What does step 4 BTS/SIGN child asthma state?
Increase ICS to med dose and consider addition of fourth drug SR theophylline
What does step 5 BTS/SIGN child asthma state?
Daily use of steroid tab, maintain med dose ICS, consider other treatment to reduce
Which inflammatory cell is involved in asthma?
Eosinophils
What are the advantages of xanthines in the treatment of asthma?
Increase endogenous cAMP
Enhance B2 agonist effects
Antagonists at adenosine receptors
What are the aims of treatment for chronic asthma?
Control symptoms, prevent exacerbations, no need for rescue meds, achieve best possible lung function tests
Airway obstruction contributing to increased airflow resistance and hypoventilation in asthma is caused by?
mucous secretion, bronchoconstriction and airway oedema
Airway hyper-responsiveness in asthma is related to what?
Exposure to an allergen causing mast cell degranulation
