ASTHMA Flashcards
What is the rationale for drug use in Asthma?
- Symptom control and relief
- Prevention of exacerbations, acute asthma and death.
- Improve and maintain lung function and quality of life.
Explain the pathophysiology of Asthma.
- Chronic inflammatory disorder of the airways
- Inflammation is associated with bronchial hyper-reactivity
- Asthma is reversible
How is asthma diagnosed?
- combination of medical history, physical examination, and lung function tests
- Lung function tests, such as spirometry and peak flow measurements
What are the clinical characteristics of asthma?
- Early onset
- Recurrent episodes of wheezing
- Breathlessness
- Coughing
- Chest tightness
What is the underlying pathophysiology of asthma?
- Asthma is characterized by chronic inflammation of the airways
- leading to bronchoconstriction and hyperresponsiveness.
- This inflammation involves immune cells, such as mast cells, eosinophils,
What are some common risk factors for developing asthma?
- genetic predisposition (family history of asthma or allergies)
- exposure to allergens (pollen, dust mites, pet dander)
- respiratory infections in early childhood, exposure to tobacco smoke, and a history of atopy (a genetic tendency to develop allergic reactions).
How do short-acting beta-agonists (SABAs) work in asthma treatment?
- SABAs relax and widen the airways by targeting beta receptors on airway smooth muscles, providing rapid relief of acute symptoms.
What are common triggers that can exacerbate asthma symptoms?
- allergens (pollen, mould, animal dander)
- respiratory infections, cold air, exercise, smoke (tobacco or wood),
- strong odours, air pollution, and irritants like perfumes or cleaning products.
What is the role of inhaled corticosteroids (ICS) in asthma management?
- ICS reduce airway inflammation
- preventing exacerbations and
- controlling chronic symptoms.
What are long-acting beta-agonists (LABAs) used for in asthma treatment?
- LABAs provide sustained bronchodilation and are used as adjunct therapy for long-term control of asthma symptoms.
What is the main inflammatory mediator of Asthma?
- Eosinophils
What are the drugs that may trigger Asthma?
- Aspirin
- NSAIDs
- Beta-blockers
What are the drug choice for Asthma?
Inhaled corticosteroids (ICS), Short-acting beta 2 agonists (SABAs), Long-acting beta 2 agonists (LABAs) if using LABA for Asthma, always use with an ICS, Montelukast, Long-acting anticholinergics aka long-acting muscarinic antagonists or LAMAs, Monoclonal antibodies
What is the purpose of combination inhalers in asthma treatment?
- Combination inhalers contain both ICS and a LABA
- addressing both inflammation and bronchodilation in one inhaler.
What is the main purpose of SABAs in asthma treatment?
- SABAs like Salbutamol and terbutaline provide rapid relief by relaxing airway muscles, helping to relieve acute bronchoconstriction.
When are SABAs typically used?
- SABAs are used as rescue inhalers during acute asthma symptoms or before exercise to prevent exercise-induced bronchoconstriction.
How do LABAs differ from SABAs in asthma management?
- LABAs such as Formoterol and salmeterol provide prolonged bronchodilation and are used as part of long-term control therapy.
Are LABAs meant to be used as monotherapy in asthma treatment?
- No, LABAs are generally used in combination with inhaled corticosteroids (ICS) for better control of asthma symptoms.
What is the primary role of ICS in asthma management?
- ICS, like Budesonide and Fluticasone, reduce airway inflammation, prevent exacerbations, and help control chronic asthma symptoms.
Are ICS used for immediate relief during acute asthma attacks?
- No, ICS are not fast-acting and are mainly used for long-term control of asthma.
How do Leukotriene Receptor Antagonists, such as Montelukast, work in asthma therapy?
LTRAs block the action of leukotrienes, which are inflammatory molecules, helping to reduce inflammation and bronchoconstriction.
What is the primary function of SAMAs and LAMAs in managing respiratory diseases?
- SAMAs like Ipratropium and LAMAs like Tiotropium act as bronchodilators by blocking muscarinic receptors in the airways.
If asthma control is not achieved, what should be considered?
- Check inhaler technique, address adherence issues, identify triggers, and assess comorbid conditions. Consider stepping up treatment.
What step-up options are available if control is not achieved with current treatment?
- Increase ICS dose, add a long-acting beta-agonist (LABA) if not already included, or consider other add-on therapies like leukotriene receptor antagonists (LTRAs).
What are 2 medications that may trigger Asthma?
Aspirin & NSAIDs – bronchospasm +/- rhinitis
How does an asthma flare up occur?
- Muscles squeezing and narrowing the airway causing mucosal obstruction
What are three differences between treatment of asthma and COPD?
- In asthma, you can step up or down wheras in COPD you only go up
- In asthma, you use LABAS ONLY with an ICS whereas COPD, you use LABAS on their own
- LAMAs are the main treatment for COPD whereas with asthma, it is ICS
- LTRAs are used in step 5 of asthma wheras you don’t use it at all in COPD
- SAMAs are better with COPD
What are two similarities between asthma and COPD treatment?
- Step wise and based on severity
- All patients should have a fast acting bronchodilator
What is the general approach to adjusting asthma treatment?
- Depends on symptom frequency, severity/impact of symptoms and history of flare ups
- Good control is daytime symptoms for less than 2 days a week, the need for a SABA less than 2 times a week and no limit on daily activities
What should you check before you step up asthma treatment? (4 marks)
- Check symptoms
- Check technique is correct
- Check adherence to treatment
- Check modifiable risk factors
What are the four steps of treatment in asthma for adults?
- 1st step- daily ICS and SABA reliever or budesonide-formoterol (low dose as needed)
- 2nd step- daily ICS and LABA (low dose) add SABA if needed
- 3rd step- daily ICS and LABA (medium to high dose) add SABA if needed
- Specialist treatment
What are two differences in asthma treatment for adults vs children?
- A LABA is a better add on than ICS as age increases
- A LTRA is more appropriate for younger patients
What are the four steps of treatment for asthma in children (Remember: treatment at stage 3 is different for 1-5 yr olds and 6-11 yr olds)
- 1st step- SABA reliever
- 2nd step- regular preventer (ICS or montelukast) and reliever
- 3rd step
- 1-5: stepped up regular preventer (low dose ICS and montelukast or high dose ICS) and reliever as needed
- 6-11: ICS (high dose), ICS/LABA combination (low dose) or ICS (low dose) and montelukast
What is an example of a SABA and two adverse effects?
- Salbutamol and terbutaline
- AEs- tremor, palpitations and headache
What is an example of a ICS and two adverse effects?
- Budesonide and ciclysonide
- AEs- Sore mouth, hoarse voice, adrenal suppression, osteoporosis and oral candestasis
What is an example of a LABA and two adverse effects?
- Eformoterol and salmeterol
- AEs- tremor, palpitations and headache
What is an example of a LTRA and two adverse effects?
- Montelukast
- AEs: headache, ab pain and diarrhoea
What should you monitor with asthma and COPD treatment?
- Inhaler technique
- Exacerbations
- Respiratory distress
