Asthma Flashcards
What is the peak flow of moderate acute asthma
Peak flow >50%
Are moderate acute asthmatic patients able to complete full sentences
Yes
What is the SpO2 in moderate acute asthma
> or equal to 92%
What is the respiratory rate of moderate acute asthma
< or equal to 30 (children 5+)
< or equal to 40 (children 1-5)
What is the peak flow of severe acute asthma
Peak flow 33-50% (Fev)
Are patients who have severe acute asthma able to complete full sentences
No
What is the respiratory rate of severe acute asthma
> or equal to 25 (adult)
30 (children 5+)
40 (children 1-5)
What is the heart rate of those with sever acute asthma
> 125 BPM (children 5+)
140 BPM (children 1-5)
What is the peak flow of those who have life threatening acute asthma
< 33%
What is the SpO2 for those with life threatening acute asthma
< 92%
What are some of the side effects of life threatening acute asthma
Cyanosis
Silent chest
Altered consciousness
Hypotension
Exhaustion
How do you manage moderate acute asthma in adults
Home or in primary care- hospital if inadequate response
Treatment: high dose SABA (salbutamol) via PMI or spacer
Give 8-10 puffs of salbutamol one after the other until adequate relief in people who have an asthma attack
How do you manage severe or life threatening acute asthma
Hospital immediately
Treatment : high dose SABA (salbutamol ) via oxygen-driven nebuliser +/ nebuliser ipratropium
How do you manage a near fatal or life threatening with poor response to initial therapy
IV aminophylline
What must all patients have when managing acute asthma in adults
all patients: oral prednisolone for 5 days- if inappropriate: IV hydrocortisone or IM methylprednisolone
In hypoxaemic patients: supplementary oxygen (maintain SpO2 between 94-98%)
What is the acute asthma management for children 2 years and over
Severe or life threatening- hospital immediately (oxygen in life threatening acute asthma or SpO2 <94%)
First line treatment: SABA (salbutamol)
-mid to moderate: PMI and spacer- medical attention if symptoms are not controlled with up to 10 puffs
- sever or life threatening- via an oxygen driven nebuliser
In all cases: 3 days oral prednisolone
Poor initial response to beta2 agonist: add nebulised ipratropium
In response to first line treatments: IV magnesium sulfate
How do you manage acute asthma for children under 2 years old
All children under 2- hospital setting
Moderate and severe: immediate oxygen + trail of SABA
If needed combine nebulised ipratropium bromide
What lifestyle changes would you recommend with someone with chronic asthma
Weight loss in overweight patients
Smoking cessation
Breathing exercise programmes
What is the chronic asthma management plan on adults
Step 1: intermittent reliever (SABA)
Step 2: SABA + low dose regular preventer (Inhaled CorticoSteroid)
- start ICS if asthma is uncontrolled by SABA alone (use SABA 3X a week, symptoms 3x a week, night time awakening at least once a week, using >1 inhaler per month
Step 3: SABA + ICS
- LTRA such as montelukast (NICE)
- LABA (BTS/SIGN)- fixed dose or as MART (maintenance and reliever therapy)
* MART using regular medication has a reliever aswell such as FOSTAIR (Combination of LABA and ICS) or symbicort
LABA stands for long acting beta-adrenoceptors agonist or long acting bronchodilator inhalers
Step 4: LABA if not already added
- can be given with or without LTRA
- can convert fixed dose LABA + moderate strength ICS into MART
Step 5: increase strength to high strength ICS or initiate (specialist)
Such as clenil 250mg
- theophylline
-tiotropium
Oral corticosteroid like prednisalone
- monoclonal antibodies
What is the low dose for an inhaled corticosteroid for beclametasone
100mg 2 puff BD
Name some inhaled corticosteroid used in asthma
Beclometasone
Budesonide
Ciclesonide
Fluticasone
Mometasone
What is the only LTRA
Montelukast
What is the asthma treatment pathway for children over 5
Step 1: intermittent reliever (SABA)
Step 2: SABA + regular preventer (ICS)- very low strength (paediatric) eg clenil 50mcg 2puffs a day twice a day
- start ICS if asthma is uncontrollable by SABA alone (use SABA 3x a week, symptoms 3x a week, night time awakening at least once a week, using >1 inhaler per month)
Step 3: SABA + ICE+
- LTRA
-LABA: if aged 12+
Step 4: Replace LTRA with LABA if not already on LABA
- can be given as MART (maintenance and reliever therapy) if still no change
Step 5: Increase ICS strength or initiate specialist
-oral corticosteroid
- theophylline
Monoclonal antibodies
- tiotropium (12+)
What is the treatment pathway for children under 5
Step 1: intermittent reliever (SABA)
- if using more than one device per month- urgent referral
Step 2: SABA + regular preventer (ICS)- very low strength (paediatric) 50 clenil
- start if asthma is uncontrolled by SABA alone (Symptoms 3x a week, night time awakening at least once a week)
- use a paediatric moderate dose for an 8 week trial to see if it works before continuing
- if ICS is not tolerated- an LTRA (montelukast) can be used instead take off the ICS and use the montelukast
Step 3: SABA + ICS + LTRA
-if still not controlled- stop LTRA and refer to specialist
What is the dropping down regimen for inhalers
- when asthma has been controlled for at least 3 months
-patients should be regularly reviewed when decreasing treatment
- patient should be maintained at the lowest possible dose of ICS
— reduction considered every 3 months- 25-50% each time
What are the symptoms of complete control of asthma
No daytime symptoms
No night time awakening symptoms
No asthma attacks
No need for rescue medication
No limitations on activity including exercise
Normal lung function (FEV, and/or PEF > 80% predicted or best)
Minimal side effects from treatment.
