Asthma Flashcards
how do we characterize asthma
hyperactive airway
bronchoconstriction
reversibility of airway obstruction
how do we diagnose asthma in childhood
chronic persistent cough
responds to bronchodilator
how do we diagnose asthma in general
FEV 1 increase of greater than 12% 15-20 mins following inhalation of salbutamol
20% improvement of PEF from baseline
symptoms and signs of asthma
coughing wheezing dyspnea chest tightness precipitated by a range of factors
difference between Asthma and COPD
COPD is irreversible COPD are smokers chronic productive cough persistent breathlessness not seasonal no day to day variability unfavorable response to glucocorticoids
how to diagnose COPD
smoking history (more than 10 years)
chronic cough
chronic dyspnea
how do we assess asthma severity
mild- day symptoms less than twice a week, night symptoms less than once a month and PEF of greater than 80% mild 2- daytime 3-4 times a week night 2-4 times a month PEF more than 80 moderate- PEF 60-80% night symptoms more more than 4 times a month and day more than 4 times a week severe- continuous daytime and frequent night time symptoms PEF less than 60
relivers
short acting bronchodilators
salbutamol- short acting b2 agonists
use when need in chronic persistent asthma
anticholinergics
ipratropium bromide- less effective than b2
onset of action 30 mins
controllers
drugs with anti- inflammatory and sustained bronchodilator action inhaled cortico beclomethasone- 200mg 12 hourly if not controlled double if not, switch to salmeterol and fluticasone 50/250 1 puff 12 hourly oral cortico prednisone b2 agonists salmeterol formoterol
how to assess control
if controlled: no exacerbations normal lung function reliever meds no nocturnal symptoms no limitation in activity less than 2 day time symptoms per week
mechanism of action of inhaled corticosteroids
bind to GC receptors- alter gene expression and cause anti- inflammatory action
side effects of inhaled cortico
orophary candidiasis
hoarseness
long acting B 2 agonists mech of action
bind to b2 receptors- stimulate adenylyl cyclase and increase CAMP leading to bronchodilation
no inflammatory effect
always use with glucocorticoids
side effects tremor/ palpitations
theophylline mechanism of action
non selective inhibition of phosphodiesterase resulting in bronchodilation and anti-inflammatory effects(inhibits release of mediators
add on therapy
side effects of Theophylline
side effects
nausea, vomiting
arrhythmias
CNS- tremor, confusion, seizures
oral corticosteroids function
after acute exacerbation
severe and poorly controlled asthma
side effects of corticoids
hypertension fluid electrolyte disturbance anti- inflammatory growth retardation hyperglycemia peptic ulcers muscle weakness cataracts osteoporosis cushings syndrome dyslipidemia depression HPS axis adrenal atrophy and inadequate stress response
medications that aggravate asthma
NSAIDS, aspirin, beta blockers
why would asthma be poorly controlled
poor adherence
poor technique
exposure to triggers
confusion of when to use reliever or inhaler
might not be asthma- heart failure, COPD, GORD, foreign body aspiration in kids
rhinitis or sinusitis
acute management of asthma
beta 2 agonist by nebuliser or spacer
corticosteroids oral prednisone or iv hydrocorisone
IP bromide if response to salbu is poor
iv magne sulphate
why should we not use intravenous aminophylline
do not use intravenous aminophylline- leads to increased side effects (vomiting and dysrhythmias)
classify COPD
mild- FEV more than 80 and predicted symptoms of cough and sputum
management of COPD
Salbutamol with spacer
if no response give LABA
if inadequate control add theophylline slow release 200 mg at night
do not give oral corticosteroids for stable COPD
what is meant by acute exacerbation of COPD
worsening of dyspnoea
increased cough
increased sputum
(exclude CF,PE and pneumonia)
how do we manage exacerbation of COPD
nebulised salbutamol
IP bromide
start prednisone if cant take oral give hydrocortisone
discharge with 40mg of pred for 5 days
amoxicillin 500 mg 8 hrly for 5 days
add clavulanic acid for 5 days if recent amoxicillin exposure
