Asthma

Question 1

What are the steps in asthma management? PHARMACOLOGICAL 2022

Answer 1

The British Thoracic Society (BTS) guidelines for asthma management are simplified
below:

STEP 1: SABA (e.g. salbutamol)

STEP 2: Inhaled LOW-dose ICS (e.g. budesonide) + SABA
(go to step 2 if asthma pump having to be used more than 3 times a week. or Paroxysmal ND)

STEP 3: Inhaled SABA + low dose ICS + LTRA

STEP 4: Low dose ICS + LABA +- LTRA (oral)
SABA prn

STEP 5: MART +- LTRA
SABA prn

Step 6: Increase dose ICS to Medium (in the MART or separately) if unresponsive

Step 7: Specialist
STEP : Consider trials of theophylline, oral beta agonists,
STEP : Oral corticosteroids - prednisolone

NOTE; NICE and BTS guidance are diffrent but both acceptable

Question 2

How would you explain asthma to a patient?

Answer 2

Asthma is a common long-term condition of the airways

where the airways are more sensitive than norrmal to common exposures eg dust

leading to diferent levels of airway tightening

3 main features; airway inflammation, obstruction, bronchial hypersensitivity

Question 3

what are the aims of asthma therapy?

Answer 3

no daytime symptoms
• no night-time awakening due to asthma
• no need for rescue medication
• no asthma attacks
• no limitations on activity including exercise
• normal lung function (in practical terms FEV1 and/or PEF>80% predicted or best)
• minimal side effects from medication.

Question 4

What do you do before starting new drug in asthma?

Answer 4

Check adherence with existing therapies ,

Check inhaler technique

Eliminate trigger factors

Question 5

Investigations and findings in asthma?

Answer 5

1. Spirometry: Gold
   A. FEV1/FVC1 ratio - will be <80% of expected
   B. A bronchodilator reversibility test - reversibility of airflow obstruction to short-acting bronchodilator; ( improvement in FEV₁ by >12% and >200 mL from baseline)
2. Fractional exhaled nitric oxide*
3. PEF
   - to show variability during the day!
4. FBC:
   normal or raised eosinophils and/or neutrophilia
5. CXR: exclude other pathology

*- used to follow patients over time and monitor adherence to treatment.
Allergic asthma;
6. Skin prick allergy test RAST
7. Allergen IgE

Question 6

other mx of chronic asthma?

Answer 6

Weight loss
smoking cessation
trigger avoidance
vaccinations - eg flu yearly

Question 7

side effects of salbutamol?

Answer 7

Tacchycardia
Tremor
hypokalaemia

Question 8

side effects of ICS?

Answer 8

Oral candida

Altered taste or voice

Systemic effects

-> Rinse mouth post use

Question 9

what question do we ask when patient comes with asthma to assess severity/progress?

Answer 9

Have you had usual symptoms during the day?

Any interference with usual activities?

Difficulty sleeping?

Question 10

when do you reduce maintenance therapy?

Answer 10

Asthma well controlled for >3months