asthma Flashcards
what is asthma?
- Is a chronic inflammatorydisorder of the airways
* inflammation is associated with bronchial hyper-reactivity
pathophysiology of asthma
- Increase in bronchial smooth muscle
* Loss of normal bronchial elasticity
presentation of asthma
Early onset, classical wheezing and often a trigger, chest tightness, shortness of breath
asthma: aspirin and NSAIDS
may trigger bronchospasm and rhinitis
diagnosis of asthma
Spirometry measures Lung Volumes/Pulmonary Functions
aims of asthma treatment
–Enable normal activity –Promote normal lung function –Reduce day to day symptoms –Prevent reduce acute attacks/exacerbations –Minimise adverse effects of treatment –Meet patient / carer expectations
shorting acting beta agonist SABA
e.g. Salbutamol, terbutaline
bronchodilators . They relax the muscles lining the airways that carry air to the lungs (bronchial tubes)
Long-acting beta-agonist: LABA
e.g. Formoterol, salmeterol, vilanterol
relax airway smooth muscle by stimulating β2-adrenergic receptors.
Inhaled Corticosteroid: ICS
e.g. Budesonide, Fluticasone (propionate or furoate)
suppress inflammation mainly by switching off multiple activated inflammatory genes through reversing histone acetylation via the recruitment of histone deacetylase 2 (HDAC2)
Leukotriene receptor antagonist: LTRA
e.g. Montelukast
It works by blocking the action of leukotriene D4 in the lungs resulting in decreased inflammation and relaxation of smooth muscle.
SAMAs-Short Acting Muscarinic Antagonists
Ipratropium
cause bronchodilation by blocking the bronchoconstrictor effect of acetylcholine on muscarinic receptors in airway smooth muscle.
LAMA- Long Acting Muscarinic Antagonists (Tiotropium)
by competitively blocking the cholinergic response manifested by acetylcholine (ACh)
Cromones
Nedocromil Sodium
Inhibit early and late stage responses to allergens
Fallen from favour in recent years
Theophyllines
smooth muscle relaxation (i.e., bronchodilation) and suppression of the response of the airways to stimuli (i.e., non-bronchodilator prophylactic effects).
asthma treatment depends on
- Frequency of symptoms
- Severity / impact of symptoms
- History of flare-ups
starting treatment for adults
•ICS regularly (preventer)
PLUS
•SABA prn (reliever)
LABAs for children
not recommended
rountinely used at step 3 for children
A LTRA is more likely to be appropriate in younger patients
before stepping up
- Check symptoms are due to asthma
- Check inhaler technique is correct
- Check adherence and persistence with treatment
- Consider modifiable risk factors e.g. smoke exposure
ICS use requires
–Oro-pharyngeal deposition increases risk of sore mouth, oral candidiasis and hoarse voice
–Rinsing mouth after use
–Clean teeth after use
–Attending for review important
can cause
–adrenal suppression
–osteoporosis
