Asthma

Question 1

what are the 4 signs of severe asthma?

Answer 1

can’t speak in full sentences
RR > 25
HR > 110
PEFR < 50%

Question 2

what are the 7 features of life threatening asthma?

Answer 2

33-92-CHEST

< 33% PEFR
< 92% pulse oximetry

Cyanosis
Hypotension
Exhaustion + feeble resp effort
Silent chest
Tachy or bradycardia

Question 3

acute asthma - treatment

Answer 3

high flow oxygen
high dose salbutamol nebs
high dose IV hydrocortisone

not improving:
ICU assessment
ECG monitor
repeat nebs with ipratropium
?single dose IV MgSO4
repeat PEFR and gases

Question 4

LRTAs - examples + role

Answer 4

block leukotriene receptors, which are involved in inflammatory cascades + resultant airway oedema, smooth muscle contraction + also hayfever sx

reduce inflammation
reduce allergic responses - in allergic reaction, body releases leukotrienes which causes airways to become inflamed

montelukast

Question 5

asthma - explanation

Answer 5

airways sensitive + inflamed + react to things they don’t like

1) muscles tighten - narrowing
2) lining inflamed - swell
3) sticky phlegm - narrowing

Question 6

SABAS/LABAs - MoA

Answer 6

beta AGONISTs

act on b2 receptors to relax bronchial smooth muscle wall

Question 7

theophylline - role? caution?

Answer 7

oral - regular LA med
IV - emergency - aminophylline

smooth muscle relaxant
reduced allergic responses

inhibit phosphodiesterase (which breaks down cAMP in smooth muscle) -> increase in cAMP -> bronchodilation
binds to adenosine A2b receptor + blocks adenosine-mediated bronchoconstriction
reduces airway response to allergens + histamine

narrow therapeutic index + reacts w a lot of things. levels easily raised by eg caffeine, cigs, meds + comorbidities - need reg blood levels

Question 8

asthma management - stepwise

Answer 8

1) newly-diagnosed + sx <3/wk:
SABA

2) not controlled on SABA, or
newly diagnosed + sx >2x/wk or night waking:
SABA + ld ICS

3) SABA + ld ICS + LTRA
4) SABA + ld ICS + LABA ± LTRA (continue if helped)
5) SABA + ld ICS MART ± LTRA

6) SABA + md ICS MART ± LTRA
OR go back to separate LABA + mod dose ICS

7) SABA ± LTRA and:
high dose ICS
trial adjunct eg LAMA or theophylline

Question 9

difference between ICS + LABA separate and them in a combo inhaler (MART - maintenance + reliever therapy)?

Answer 9

MART - ICS + LABA combo when the LABA is fast-acting so can be used as a reliever, eg formoterol

used for daily maintenance + relief of sx prn

Question 10

what constitutes low, mod + high dose ICS in adults?

Answer 10

low - <400mcg budesonide
mod - 400-800
high - >800