Asthma Flashcards
What drug class is Ipatropium?
SAMA (SHORT ACTING MUSCARINIC ANTAGONIST)
What drug class is tiotropium?
LAMA (LONG ACTING MUSCARINIC ANTAGONIST)
Acute asthma three levels?
Moderate
Severe
life threatening
Moderate acute asthma peak flow?
Over 50%
Severe acute asthma peak flow?
Peak flow 33-50%
Life threatening acute asthma peak flow?
Less than 33%
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
What oxygen levels in moderate severity?
Equal to or more than 92%
What oxygen levels in life threatening severity?
Less than 92% SpO2
Respiratory rate for moderate in children?
5+ child is 30 or less
1-5 child is 40 or less
Respiratory rate for moderate in children?
Over 25 in adults
Over 30 in Child 5+
Over 40 in Child 1-5
Heart rates for severe asthma? Children 1-5? Children 5+?
Child 1-5: over 140 Bpm
Child 5+: over 125 BPM
Moderate acute asthma treatment?
8-10 puffs of high dose Saba (Salbutamol) through spacer!!
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
Near fatal acute asthma - poor response life threatening? Treatment?
IV Aminophylline
After acute Asthma attack what to be given course of? Duration?
Oral Prednisolone for 5 days
If inappropriate: IV Hydrocortisone or IM Methylprednisolone
Hypoxaemic pt should be given what after acute asthma attack?
Supplementary oxygen reach to SPO2 target: 94-98%
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
