Asthma Flashcards
1
Q
Describe the rescue inhaler (salbutamol) for asthma
A
- Every patient should have this as rescue when experiencing sx
- Shouldn’t use more than 4 times per week
- Monotherapy only appropriate in very mild asthma
- Strongly encourage aerochamber
- AE = increased nervousness, HR, and headache
2
Q
Describe the maintenance inhaler (corticosteroid) for asthma
A
- Every patient should be on this for maintenance
- Always start at lowest possible dose
- Can increase dose if asthma not controlled in 6-11 year olds
- AE = thrush and hoarseness; sx decreased w/ spacer and rinsing mouth after use
3
Q
Describe the use of LABA for asthma
A
- Add on to steroid for those 12 years and older w/ uncontrolled asthma
- Steroid/LABA combination inhaler (ex: Symbicort, Advair, Breo) preferred for adherence
- If using Symbicort, can increase to 8 puffs/day as reliever and controller during flare
- AE = same as SABA
4
Q
Describe the use of LTRAs (montelukast) for asthma
A
- Help w/ allergic component
- Prevent further inflammation (better for prevention than tx)
- AE = headache, rash
5
Q
Describe asthma exacerbation management
A
- Exacerbation = acute worsening of sx from baseline
- Repetitive administration of rapid-acting beta 2 agonist -> 4-10 puffs every 20 mins for 1 hour, then if stable 2-4 puffs PRN (ex: every 1-4 hours)
- Early introduction of systemic corticosteroids (kids = prednisone 1-2 mg/kg/day * 3-5 days; adults = prednisone 50 mg daily * 5-7 days)
- Short term AE = hyperglycemia, increased appetite, fluid retention, mood alteration
- Oxygen supplementation
6
Q
Describe asthma post-exacerbation management
A
- May continue SABA 2-4 puffs every 1-4 hours until sx resolve
- Step up tx (increase ICS dose or add LABA) and monitor over 1-3 months, then may consider reducing ICS to lowest effective dose
7
Q
Describe exercise-induced bronchoconstriction
A
- Develops 5-10 mins after completing exercise and resolves spontaneously w/in 30-45 mins
- If underlying asthma, may indicate poor control -> step-up controller therapy
- If no underlying asthma, yet require SABA prior to exercise -> get a spirometry
- If pt needs SABA more than 3 times/week (including for exercise) -> need an ICS (poor control)
8
Q
Drug interactions w/ asthma meds
A
- ICS -> 3A4 inhibitors may increase fluticasone and budesonide serum concentrations
- LABA -> 3A4 inhibitors may increase AE of salmeterol
9
Q
Asthma red flags
A
- Any child under 6 y/o (refer to specialist)
- Unable to speak
- SOB at rest
- Reliever not working
- Peak flow < 60% predicted best
- Pt knows from past experience they are having a serious attack
10
Q
Case specific assessment questions for asthma
A
Adherence, triggers, technique!!
- How do you use your inhalers?
- Do you know what triggers an asthma attack for you? Do you try to avoid it as much as possible?
- How many days in the week do you have symptoms? (want less than 4)
- How many nights in the week do you have symptoms? (want less than 1)
- How often do you use your rescue inhaler in a week? (want less than 4 including exercise)
- How often do you have exacerbations?
- Do you miss any school or work due to your asthma? (want none)
- How is your physical activity? (want it to be normal)
- Do you have an action plan?
- How often do you measure your breathing? (should be twice a day)
- Have you had a spirometry? (only way to diagnose)
- Do you use an aerochamber?
11
Q
Yellow zone recommendations for asthma (based on age)
A
- For 11 years and younger -> prednisone 1 mg/kg * 3-5 days
- For 12 years and older -> quadruple ICS for 7-14 days
12
Q
Non-pharms for asthma
A
- Avoid triggers
- Annual flu shot
- Healthy diet
- Encourage physical activity
- Breathing exercises
13
Q
GENERAL follow-up for asthma
A
- Always assess adherence, triggers, and technique
- Follow up at every visit and reassess if asthma is still controlled
- Follow-up in 1-3 months for every dose increase or addition of new inhaler
- Maximum sx improvement w/ steroids in 4-8 weeks; follow-up 1-3 months after starting tx
14
Q
Describe monitoring for post-asthma exacerbation
A
- Monitor for signs & sx of exacerbation daily/weekly & for SE of the drug
- Should be scheduling the SABA to 4-10 puffs every 20 minutes for 1 hour, then if stable 2-4 puffs PRN (q1-4h)
- SABA SE -> headache, increased HR, increased excitability
- Should be prescribed prednisone if doesn’t respond to SABA in 6-8 hrs. Depending on how long the steroids are prescribed (3-5 days), sx should be improving within 1-2 days and should be almost completely gone by the time the course is finished
- Prednisone SE -> “most of the side effects of this drug only occur after long-term use of the drug, however when you take it for only a short period of time you may experience insomnia or GI upset”
15
Q
When to go to a doctor post-asthma exacerbation
A
Go to doctor if sx have not improved at all or only minimally after full tx course
