Asthma

Question 1

Mx asthma in adults?

Answer 1

1. SABA
2. SABA + inhaled corticosteroid 200-800mcg/day
3. Add LABA, continue if good response, increase steroid to 800. Add in leukotriene or theophylline if required
4. Increase steroids up to 2000mcg/day. Add in leukotriene receptor antagonist, SR theophylline or B2 agonist tablet
5. Daily steroid tablet, inhaled steroid up to 2000mcg/day. Refer to specialist

Question 2

What are some e.g. of SABA?

Answer 2

Salbutamol, terbutaline, adverse effects

Question 3

What are adverse effects of SABAs?

Answer 3

Fine tremor
Palpitations
Tachycardia
Headaches
Tachyarrhythmias

Question 4

What are uses of SABAs?

Answer 4

Mx asthma
Acute hyperkalaemia
Tocolytic to delay premature labour

Question 5

How may salbutamol be administered?

Answer 5

MDI- 200 micrograms

Nebulised solution- 2.5 or 5mg

Question 6

How is terbutaline commonly prescribed?

Answer 6

Turbuhaler- used for patients with difficulty coordinating

Question 7

When should inhaled steroids be prescribed in mx of asthma?

Answer 7

Patients requiring B2 agonists more than twice a week, nocturnal sx or recent exacerbate requiring systemic steroids in past 2 years

Question 8

What is the standard inhaled corticosteroid prescribed in asthma?

Answer 8

Beclamethasone

Others- budesonide, fluticasone

Question 9

What are the adverse effects of inhaled corticosteroids in asthma?

Answer 9

Oral candida
Adrenal suppression

reduced when inhaled.
Rinse mouth after inhaler to reduce candida risk

Steroid card if on high dose inhalers

Question 10

What are the most frequent LABAs prescribed in asthma?

Answer 10

Salmeterol or formeterol

Question 11

What is in a seretide inhaler?

Answer 11

Combination of salmeterol and fluticasone

Question 12

What is in a symbicort inhaler?

Answer 12

Combination of formeterol and budesonide

Question 13

What is in a fostair inhaler?

Answer 13

Combination of formeterol and beclomethasone

Question 14

What are examples of leukotriene receptor antagonists?

Answer 14

Montelukast

Zafirlukast

Question 15

How do leukotriene receptor antagonists work?

Answer 15

Block leukotrienes- pro-inflammatory mediators

May have synergistic effect with inhaled corticosteroids

May have role in exercise-induced asthma

Question 16

What condition can be associated with leukotriene receptor antagonists?

Answer 16

Churg-Strauss

Question 17

How does theophylline work?

Answer 17

Xanthine bronchodilator with narrow therapeutic window

Question 18

Why should oral theophylline be prescribed by brand?

Answer 18

They are not bioequivalent

Question 19

What are adverse effects of theophylline?

Answer 19

GI disturbance, anxiety, tachycardia and tremor

May be fatal in OD

Question 20

What is omalizumab?

Answer 20

Mab that binds to IgE used in allergic asthma

For specialist use only

Question 21

When do you need to titrate oral steroid dose down?

Answer 21

If received >40mg prednisolone (or equivalent) daily for more than 1 week

If received more than 3 weeks treatment

Recently received repeated courses (especially if >3 weeks)

Taken a short course within 1 year of stopping long term therapy

Question 22

What is a typical reducing regime of oral steroids?

Answer 22

Reduce by 2.5mg every 3-4 days, down to 7.5mg per day

Then reduce more slowly- e.g. 2.5mg every 1-2 weeks

Question 23

Who does not require titration of oral steroids?

Answer 23

Those whose disease is unlikely to relapse

Those who have received treatment for 3 weeks or less