Asthma Flashcards
(24 cards)
What is it?
Chronic inflammatory condition of the airways characterised by bronchoconstriction
What are symptoms of asthma?
Cough, wheezing, chest tightness and SOB
What is treatment line for asthma ages 5 and over?
1st line;
SABA- salbutamol
2nd;
Inhaled ICS -
fluticasone/mometasone equal clinical activity to Beclometasone and Budenoside at half dose
3rd; LABA salmaterol, formetrol used in conjunction with ICS
4th line;
LKRA or Theophylline or Beta agonist MR ;
Montelukast
5th line;
add oral regular corticosteroid (lowest tolerated dose)
Why should Inhaled ICS be avoided in children where possible?
High doses of ICS can be associated with growth failure, reduced bone mineral density and adrenal suppression.
What is treatment of asthma in children under 5?
1st line: SABA
2nd line; Inhaled ICS or LKRA
3rd line; Inhaled ICS or LKRA
4th line; refer to specialist
What is treatment in pregnancy and breastfeeding?
All the same as adult treatment.
LKRA has limited information on pregnancy so used if risks outweighs benefits.
Important to achieve good asthma control, if this is achieved it has no important effects on pregnancy, labour or the foetus.
What is treatment if exercise is a specific problem?
If already taking ICS, consider adding LKRA, LABA, oral Beta 2 antagonist, sodium cromoglicate, theophylline.
ACUTE ASTHMA:
What is management acute asthma attack?
1st; high dose SABA ASAP
adequate dose of prednisolone once daily for 5 days or until recovery.
if non-life threatening- a pMDI with spacer is preferred
if Life threatening- beta-2 agonist given by oxygen-driven nebuliser
ACUTE ASTHMA:
What is given to patient with severe acute asthma and why?
To ALL patients with severe acute asthma;
supplementary oxygen to maintain spO2 levels between
94-98%
Nebulised ipatropium bromide may be combined with nebulised beta2 agonist- this provides greater bronchodilation
ACUTE ASTHMA:
What element can be used as a bronchodilator?
Magnesium sulphate
What are examples of bronchodilators?
SABA
LABA
Oral beta 2 agonist
What bronchodilators are safest and most effective in asthma?
Salbutamol
What bronchodilators are least safe and why?
Ephedrine, they are least selective and therefore more likely to cause arrhythmias and other side effects
What bronchodilator is best for nocturnal asthma?
LABA
What bronchodilators should NOT be used in acute asthma attacks?
Salmeterol due to its slower onset of action
what is formeterol and what is it used for ?
A LABA
licensed for short term symptom relief and for prevention of exercise induced bronchospasm.
What are the two types of antimuscarinic bronchodilator, how do they differ?
ipatropium bromide
This is a SAMA, max effects occurs in 30-60mins and duration is 3-6 hours
bronchodilator can be maintained by TDS doses.
Tiotropium;
LAMA
used with ICS and LABA for patients who have experienced 1 or more exacerbation in the last year.
What are common side effects of antimuscarinic bronchodilators?
Dry mouth and glaucoma
How long is salbutamol duration of action?
3-5 hours
What side effects of salbutamol?
muscle cramps
hypokalaemia ( with high doses)
What are common interactions with salbutamol?
Increased risk of hypokalaemia when given with theophylline or prednisolone.
What are monitoring requirements of salbutamol?
uncomplicated premature labour; monitor blood pressure, pulse rate (should not exceed 120 beats per minute), ECG (discontinue treatment if signs of myocardial ischaemia develop), blood glucose and lactate concentrations, and the patient’s fluid and electrolyte status
What are side effects of ALL Beta-2 agonist?
Arrhythmias; headache; palpitations; tremor
hyperglycaemia but uncommon
What are monitoring requirements of all selective beta-1 agonists?
hypokalaemia
gylcaemia
