Asthma Flashcards
What is asthma (definition)?
Chronic inflammatory disease characterised by recurrent attacks of breathlessness and wheezing.
LABA work on which aspect of asthma pathophysiology?
The smooth muscle dysfunction.
ICS work on which aspect of asthma pathophysiology?
The airway inflammation.
Smooth muscle dysfunction in asthma consists of?
Bronchoconstriction
Bronchial hyper-reactivity
Hyperplasia
Inflammatory mediator release
What does SIMPLE stand for?
Stop smoking. Inhaler technique Monitoring Pharmacotherapy Lifestyle Education
What would a young teenager newly diagnosed with asthma typically be prescribed?
Salbutamol Inhaler
ICS (Spacer)
What symptoms indicate a high probability of an asthma diagnosis?
Cough Wheeze Worse at night Exercise induced Family history Widespread wheeze Evidence of airway narrowing.
What symptoms are likely to indicate a differential diagnosis to asthma?
Cough BUT NO wheeze or SOB. Dizzy & lightheaded. No airway narrowing Voice disturbance Symptoms with cold only Chronic productive cough Cardiac disease
Is the nitric oxide breath test useful? How does it work?
No. FeNO in the breath of people with asthma detects lung inflammation.
What is the ACT?
Asthma Control Test.
Five Qs that refer to the last 4 weeks.
What is salbutamol?
Short acting beta agonist (SABA)
What is beclametasone?
It is an ICS.
What is a typical low dose ICS?
Beclametasone 100microgram per puff. One puff twice a day: low dose.
Two puffs twice a day: medium dose.
What is a LABA?
Either Formeterol or Salmeterol Long acting b2 agonists.
What is the initial add on therapy to asthma treatment following SABA (sulbutamol) and low dose beclametasone (ICS)?
Inhaled LABA
Formeterol/Salmeterol
Consider using combined low dose ICS and LABA in combined inhaler.
Following SABA, ICS (low dose) and LABA what can be added a an additional therapy to the management of asthma?
First of all should consider if no response to LABA - ? stopping it and increasing dose of ICS.
If LABA = benefitting, continue LABA and increase ICS to medium dose.
Can also consider trial of LTRA, LAMA etc.
What are the licensing requirements for omalizumab?
Step4/5 asthma FEV1<80% >2 severe exacerbations \+ve skin prick test or +ve RAST to common aeroallergens. IgE >50 and <700iu/ml.
What is step 1 asthma treatment?
SABA (blue) PRN
IF more than 3x week or 2x day, need to add in a trialed ICS low dose.
What is step 2 of asthma management?
If SABA PRN and low dose ICS is not enough, check inhaler technique etc and then add in a LABA such as salmeterol or formeterol.
What is step 3 in asthma management?
If SABA prn, low dose ICS and LABA are not managing patient, increase to a medium dose ICS if they have had some improvement from the low dose ICS. If no ICS benefit then a LAMA or LTRA can be considered instead at this stage.
What is step 4 of asthma management?
Patient would be on:
SABA prn, medium dose ICS + LABA.
We can now move to high dose ICS/LABA combo plus SABA prn plus a 4th drug: LAMA, LTRA, Theophylline, B agonist tablet.
What is step 5 of asthma management?
Oral corticosteroid.
How is an acute asthma attack managed?
- Nebulised bronchodilators such as salbutamol and ipaptropium if severe, driven by OXYGEN. Mg Sulphate stat one dose IV.
- Oxygen sats of 94-98%.
- Hydrocortisone IV stat followed by prednisolone 50mg for 5 days post attack.
- VTE risk assessed.
- No antibiotics unless evidence of consolidation on chest x-ray or other signs of infection.
