Asthma And Copd

Question 1

First line treatment for asthma

Answer 1

B2 agonist - salbutamol (ventolin)

Question 2

Name some other quick onset B2 agonists

Answer 2

Salbutamol, terbutaline

Fast onset long acting - fortoterol

Question 3

Second line for asthma and name example

Answer 3

Regular preventer ICS
Beclomethasone
Budesonide

(Or Luticasone)

Question 4

CHANGE THIS IS OLD GUIDLINES3rd line - add on for asthma

Answer 4

LABA - long acting B2 agonists

Formetrol
Salmetrol

Question 5

What are combined inhalers and when are they used

Answer 5

Combo of ICS and LABAs, so used in 3rd line Therapy…
Budensoisne or Beclomethasone or Fluticasone with formoterol

Fluticasone with salmetrol
Also fluc with vilanterol

Question 6

Advantages of combined inhalers

Answer 6

Easy to use, increase complience, less prescriptions - safer so dont use too much of one

Question 7

Stage 4 asthma - which medication patterns are preferred?

Answer 7

Additional add on therapy
LABA no response. Then stop and increase ICS
LABA some response. Then increase LABA and IBS
LABA some response - continue LABA and ICS and add on another therapy

Question 8

Additional add on therapies in asthma

Answer 8

LTRA - montelukast
S-R Theopylline
LAMA - Tiotropium bromide

Question 9

Name LTRA and its use

Answer 9

Montelukast

Used as an add on therapy in asthma if control is not adequate despite inc. ICS, a LABA

Question 10

What. Is Tiotripoium bromide and. How is it used

Answer 10

LAMA. - long acting musccurinic antagonist
Used in severe asthma as add on therapy
Mostly in COPD

Question 11

Last resort pharmacology in asthma - name examples

Answer 11

Continuous or frequent Oral steroids
Lowest dose possible 
Prednisolone (delatsone)
Dexamethasone - decadron
Predinisolone

Question 12

In sever asthma treated by oral steroids which other medications should be stopped/continues

Answer 12

Continue high dose ICS
Continue short acting B agonists-
Unsure about the others but too high level

Question 13

Managing acute severe asthma

Answer 13

1) high flow 02 - aim 94-98%
2) Nebulised salbutamol
3) severe?Unresponsive - add nebulised ipratropium bromide
4) IV aminopylline if no improvement
Oral prednisolone 40mg daily 10-14 days

Question 14

Managing mild COPD

Answer 14

SABA - salbutamol as required
Or SAMA - ipratropium bromide
Smoking cessation
Flu vaccine

Question 15

Severe COPD fev <50%

Answer 15

Same as moderate but add ICS
1st line - long acting B2 agonist - budensoisne
+
ICS - formetrerol

Can use in combined inhaler e.g. Symbicort

Question 16

Add on therapy for COPD (severe)

Answer 16

Specialist
LAMA - Tiotriopium bromide
+ ICS (prednisolone) +/ or Long B2 agonist (salmetrol )

Question 17

Acute exacerbations of COPD

Answer 17

Ipratropium and inhaled CS e.g. Prednisolone

Then give long FINISH
can I’ve o2 with venturi or non rebreathing mask rate limited.aim for sats <92%

Question 18

managing moderate COPD FEV1>50

Answer 18

Already tried SABA or SAMA (ipratropium ) relief

Now try LABA - salmetrol

Question 19

Overall. Summery of COPD management

Answer 19

Salbutamol./ Ipratropium relievers
Then LABA - salmetrol (+ ICS prednisolone if FEV<50%)
    Or Can try LAMA - tiotropium
LABA plus ICS
Final: LAMA plus ICS/LABA

Question 20

Terbutaline

Answer 20

Short activist B2 antagonist