Asthma and COPD Flashcards
What is complete control of asthma defined as (6)
- no daytime symptoms
- no night-time awakening due to asthma
- no asthma attacks, no need for rescue medication
- no limitations on activity including exercise
- normal lung function
- minimal side-effects from treatment
what non-pharmacological advice can you give to asthmatic patients (5)
- life style advice
- weight loss
- smoking cessation
- avoiding triggers
- breathing exercise programmes
what is the initial treatment for asthma?
SABA + ICS
name two SABAs
salbutamol, terbutaline
name two LABAs
salmeterol, formoterol
how do beta-2 agonists work?
smooth muscle relaxation
what are some side effects of beta-2 agonists (5)
- tachycardia
- palpitations
- anxiety
- tremor
- LABAs can cause muscle cramps
name 3 examples of inhaled corticosteroids
beclometasone
budesonide
fluticasone
how do ICS work?
down regulate inflammatory cells and upregulate anti-inflammatory proteins.
causes a reduction in mucosal inflammation, widens airways and reduces mucus secretions
what is the main side effect from ICS?
oral candidiasis
What would you add on to an asthmatic whose asthma is not well controlled by a SABA + ICS
LABA
e.g. salmeterol, formoterol
what might you check first if an asthmatic patient comes to you with poorly controlled asthma on a SABA + ICS?
- check adherence and inhaler technique
- offer a spacer device if appropriate
which has a faster onset of action: formoterol or salmeterol?
formoterol
think F for Fast
if the addition of a LABA in an asthmatic is not working what could you try (class and name of drug)
montelukast - a leukotriene receptor antagonist.
or
Long acting muscarinic receptor antagonists (ipatropium, tiotropium)
how do LTRA work?
reduce inflammation and bronchoconstriction
what is the mechanism of action of LAMAs?
inhibitor of ACh so they cause the opposite effects of parasympathetic NS so you get smooth muscle relaxation in the respiratory tract and reduced secretions.
what is the only SAMA available?
ipratropium
name the LAMAs
tiotrpium, glycopyrronium, aclidinium
Do LAMAs tend to be more useful in COPD or asthma management?
COPD.
they have a place in asthma when added to a beta-2 adrenoceptor agonist in severe exacerbations of asthma
what is the MOA for theophylline?
inhibits phosphodiesterase and blocks adenosine receptors
what is the indication for theophylline?
IV for status asthmaticus.
orally for sustained relief
what is the problem with prescribing theophylline?
narrow therapeutic window so can result in cardiac arrhythmias, seizures, GI disturbance.
also has lots of drug interactions
if a patient comes to you with well controlled asthma what might you do about his medication?
Can consider decreasing dose of ICS but do this slowly by decreasing the dose by 25-50% every 3 months
in life-threatening asthma what does the mnemonic 33, 92, CHEST stand for?
33: PEFR <33% predicted
92: sats<92%
Cyanosis
Hypotension
Exhasution
Silent chest
Tachycardia
how would you treat an acute asthma attack initially?
Oxygen in non-rebreather
SABA by oxygen driven nebuliser
Prednisolong 40mg for 5 days minimum until symptoms improve orally, or IV hydrocortisone for those unable to take oral meds
what could you add in to initial treatment to treat acute severe asthma attack
add nebulised ipratropium bromide
or
IV magnesium under specialist supervision
what non-pharmacological measures can you advise for someone with COPD?
- smoking cessation
- pulmonary rehabilitation
- Encourage physical activity
- pneumococcal and influenza vaccination to reduce risk of infection
- co-develop a personalised self-management plan
do all people diagnosed with COPD require inhalers?
not if they are not breathless and if it doesn’t interfere with exercise than it’s OK
what inhaled therapy would you first offer to a COPD patient?
SABA or SAMA to use when required
what is second line COPD in someone who has no asthmatic features or features suggesting steroid responsiveness?
LABA + LAMA
What inhalers would you try in a COPD patient already on a LABA and LAMA who is getting day-to-day symptoms that adversely impact quality of life?
add ICS to the current LABA + LAMA for 3 month trial and if it doesn’t improve revert back to LABA +LAMA
what would be second line to a COPD patient who showed signs of asthmatic features or features suggesting steroid responsiveness?
LABA + ICS
what could you try pharmacologically in a patient with COPD who shows signs of steroid responsiveness but who is already on a LABA + ICS and it is not managing the COPD effectively?
offer LABA + LAMA + ICS
