Asthma

Question 1

What is first line management of asthma in primary care?

Answer 1

Everyone with asthmatic symptoms should be prescribed a SABA.

Question 2

When would you begin second line treatment in an asthmatic?

Answer 2

This is for patients who are not gaining adequate control on a SABA alone.

OR

Those who are getting symptoms >3 times a week or waking up in the night once a week with asthmatic symptoms.

Question 3

What is the second line treatment for asthma?

Answer 3

A SABA and an ICS.

Question 4

If a SABA and low dose ICS is ineffective in asthma treatment, what should you add onto the treatment regimen?

Answer 4

A SABA, low dose ICS PLUS a Leukotriene receptor antagonist.

Question 5

If a SABA, low dose ICS and LTRA are ineffective in the management of a patients asthma, what should be done next?

Answer 5

You should add a LABA to the SABA and low dose ICS. The LTRA can be continued depending on the patients response.

Question 6

If an individuals asthma is not being adequately controlled with a SABA, low dose ICS, LABA +/- LTRA, what should be done next in their management?

Answer 6

SABA +/- LTRA.

The LABA/ICS should be switched to a MART (Maintenance and reliever therapy) that contains a low dose ICS.

Question 7

What does a Maintenance and reliever therapy inhaler contain?

Answer 7

Low dose ICS and fast acting LABA.

Question 8

If control of a patients asthma is not gained on SABA +/- LRTA and an initial MART (with low dose ICS in it), what should be done next?

Answer 8

Switch the patients MART to an inhaler with a moderate dose ICS or consider switching back to a separate LABA inhaler and a moderate dose ICS.

Question 9

What is the last line of treatment in asthmatics before referring to a specialist?

Answer 9

SABA +/- LRTA and…

• Fixed high dose ICS
• Trial an additional drug - long acting muscarinic antagonist or theophylline.