Asthma Flashcards by Deroy —

What drug class is Ipatropium?

SAMA (SHORT ACTING MUSCARINIC ANTAGONIST)

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What drug class is tiotropium?

LAMA (LONG ACTING MUSCARINIC ANTAGONIST)

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Acute asthma three levels?

Moderate
Severe
life threatening

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Moderate acute asthma peak flow?

Over 50%

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Severe acute asthma peak flow?

Peak flow 33-50%

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Life threatening acute asthma peak flow?

Less than 33%

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Acute asthma completing sentence differences in severity?

If they can complete full sentences then moderate

If unable to complete full sentence then severe

If can’t talk then Life threatening

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What oxygen levels in moderate severity?

Equal to or more than 92%

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What oxygen levels in life threatening severity?

Less than 92% SpO2

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Respiratory rate for moderate in children?

5+ child is 30 or less

1-5 child is 40 or less

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Respiratory rate for moderate in children?

Over 25 in adults

Over 30 in Child 5+

Over 40 in Child 1-5

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Heart rates for severe asthma? Children 1-5? Children 5+?

Child 1-5: over 140 Bpm
Child 5+: over 125 BPM

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Moderate acute asthma treatment?

8-10 puffs of high dose Saba (Salbutamol) through spacer!!

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Severe acute asthma treatment?

Hospital

8-10 puffs high dose SABA (Salbutamol)
Use oxygen driven nebuliser tho not a spacer like in moderate!

With/without nebulised Ipatropium

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Near fatal acute asthma - poor response life threatening? Treatment?

IV Aminophylline

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After acute Asthma attack what to be given course of? Duration?

Oral Prednisolone for 5 days

If inappropriate: IV Hydrocortisone or IM Methylprednisolone

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Hypoxaemic pt should be given what after acute asthma attack?

Supplementary oxygen reach to SPO2 target: 94-98%

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Children over 2 acute asthma moderate treatment?

Saba - Salbutamol using PMI and spacer up to 10 puffs

Children over 2 acute asthma Severe treatment? Setting?

High Dose SABA - Salbutamol via oxygen driven nebuliser

Difference between child under 2 and child over 2/ Adult moderate treatment setting?

Adult & over 2 can be done in community (10 puffs)

Child under 2 must go hospital immediately!

Child over 2 after acute asthma to be given what? Duration?

Oral Prednisolone for 3 days

Difference in duration of Oral prednisolone in child over 2 and Adult?

3 days for child over two years old

5 days - Adult

If inadequate response to Salbutamol in child over 2 acute asthma treatment through oxygen driven nebuliser, you can add what?

Nebulised Ipatropium

If no response to Ipatropium in child over 2?

Give IV Magnesium Sulphate

Under 2 Acute Asthma treatment in mod & severe?

Immediate Oxygen with trial of SABA (Salbutamol) If needed add Ipatropium

Chronic Asthma lifestyle change to do?

Lose Weigh Stop smoking Incorporate breathing exercises

Chronic Asthma First step in adults?

Salbutamol (SABA)

If not controlled by Saba alone, 2nd step in chronic asthma?

Low Dose ICS - inhaled corticosteroids Eg) Budesonide, Beclometasone, Fluticasone, Mometasone, -ide -one

After SABA ALONE what shows that Asthma is not controlled properly? Criteria? 4 criteria?

1) Pt used Saba 3 times a week 2) Symptoms for more than 3 times/ wk 3) NIGHT TIME AWAKENING <- MAJOR 4) More than 1 inhaler a month

Low dose ICS dose - Eg clenil 100?

Two puffs BD = 400mcg

If Saba and ICS is not working, next step? (Salbutamol + Beclometasone)

Add LTRA - MONTELUKAST

After Saba + ICS + LTRA , next step up?

LABA as a fixed dose or MART Eg) Tiotropium - fixed Eg) Fostair/Symbicort - MART **can remove LTRA if not useful!!

Final specialist stage after LABA has been added to SABA + ICS + LABA (+/-LTRA)

INCREASE low dose ICS —> HIGH DOSE Eg Clenil 250 Or start: Theophylline, Tiotropium, oral corticosteroids or monoclonal antibodies.

Main 2 Difference in chronic asthma treatment?

Use VERY LOW STRENGTH ICS EG) Clenil 50mcg TWO puffs BD = 200mcg If adding LABA must be: 5+

If adding LABA to child over 5 chronic asthma treatment, what requirement must be met?

LTRA must be replaced by the LABA (Cannot add on top like in Adults)

Tiotropium can be given to which age?

12years+

Children under 5 step 1 in treatment?

SABA But if using more than 1 device/month REFER!!!

Children under 5 - step 2 difference?

8 week trial of very low dose ICS - 50mcg If doesn’t work - Replace w/ LTRA MONTELUKAST

Child under 5 - step 3 in treatment?

Triple therapy can be considered SABA + ICS + LTRA (If ICS is proving to help a bit)

Child under 5 - still not controlled after triple therapy?

STOP LTRA (Montelukast) & Refer to Specialist

Can you reduce treatment and cure in way of asthma? When can you do this if so?

You can when asthma controlled for at least 3months

Every 3 months how much can you reduce dose of ICS by?

25 - 50% of total dose each time

What’s complete control?

No day time symptoms No night time awakenings No asthma attacks No need for Rescue meds No limitations from exercise Normal lung funct (FEV1 and/or PEF over 80% predicted or best) Minimum side effects from treatment