asthma

Question 1

what is the treatment steps for adults with asthma?

Answer 1

1. SABA – reliever for adults with new diagnosis (with infrequent, short-lived wheeze + normal lung function)
2. Maintenance (low dose ICS) therapy - if uncontrolled on ICS, add LTRA (review 4 to 8 weeks)
3. Add LABA +/- LTRA
4. Change ICS/LABA to MART* (ICS + LABA in single inhaler for daily maintenance/ relief of symptoms)
5. Inc maintenance dose of ICS from low to moderate
6. Inc maintenance dose of ICS from moderate to high + SABA + add LAMA or theophylline

Question 2

advantages of B2 agonists?

Answer 2

• minimised ADE
• rapid onset
• long acting forms last 8-12hrs

Question 3

disadvantages of B2 agonists?

Answer 3

• May stimulate b1 adrenoceptors (adverse effects)

Question 4

advantages of antimusarincs?

Answer 4

reduce mucus secretion

• may be useful as add-on in life-threatening acute asthma
• may alleviate acute asthma unresponsive to standard therapy

Question 5

when are antimuscarinics contraindicated?

Answer 5

benign prostatic hyperplasia, bladder outflow obstruction, narrow angle glaucoma

Question 6

what is an exmaple of a SABA?

Answer 6

salbutamol

Question 7

what are examples of ICS?

Answer 7

beclomethasone, budesonide, ciclesonide

Question 8

what is an example of an oral corticosteriod?

Answer 8

prednisolone

Question 9

when would you use an ICS?

Answer 9

Exacerbation of asthma in last 2 years
Using inhaled ß2-agonist >3 times per week
Symptomatic >3 times per week
Waking 1 night per week

Question 10

side effects of ICS?

Answer 10

hoarseness or dysphonia 
- (use spacer/dry powder)
oral candidiasis
- Rinse mouth after use/spacer
adrenal suppression
- >1500mcg beclomethasone daily

Question 11

side effects of oral corticosteroids/

Answer 11

hypertension
adrenal suppression
osteoporosis
skin thinning
hyperglycaemia
moon face 
Acne

Question 12

examples of leukotrine antagonists?

Answer 12

montelukast and zafirlukast

Question 13

ADRS of montelukast and zafirlukast

Answer 13

Abdominal pain
Headache
Thirst 
Rash
Sleep disturbance/CNS effects

Question 14

monitoring in acute astham?

Answer 14

PEF
O2 saturation (Aim 94-98%)
arterial blood gases – inc. pH for acidosis
HR/RR (tachy-cardia/ponea)
theophylline levels (if cont >24h)
serum K+ (nebulised SABA)/glucose
Hydration
WCC?
CRP