Asthma, COPD, Cystic Fibrosis, Allergies and anaphlyaxis, Croup, CF Flashcards
what’s steps 1 - 5 in the asthma treatment pathway?
- intermittent reliever - SABA
- SABA + ICS
- LTRA (NICE) or LAMA (BTS/SGN)
- LABA if not already added - can be used with ot without LTRA. Convert fixed dose LABA + oderate ICS into MART
- Increase to high dose ICS or initiate
- theophylline
- tiotropium
- oral corticosteroids
- MAbs
what symptoms must a patient display for an ICS to be added into asthma regime?
- needing SABA 3x a week
- being symptomatic 3x a week
- night waking 1x a week
- using more than 1 inhaler a month
when can LABAs be given to children for management of aasthma?
in step 3 as per adult pathway but only for 12yrs+
whats the Clenil dose for children ?
50mcg 2PU BD
what age can tiotropium be used?
12yrs +
when is the course of action to take if child under 5 is using more than 1 inhaler a month?
urgent refferal
what is step 2 for children under 5 in the asthma pathway?
- to start ICS if symptoms uncontrolled by SABA (symptoms 3x a week, night time waking x1 a week)
- use a paediatric low dose for an 8 week trial
- if ICS not tolerated use LTRA
when can you think about stepping down asthma treatment?
when asthma has been controlled for at least 3 months
how do you step down asthma treatment?
- by maintaining patients are the lowest, effective ICS dose
- reduce by 25 - 50% every 3 months
what defines complete control in asthma?
- no daytime symptoms
- no night time waking
- no asthma attacks
- no need for rescue medication
- no limitations on activity including exercise
- normal lung function (FEV1 and/or PEF >80% predicited or best)
- minimal side effects from treatment
if someone with COPD has azithromycin prescribed as prophylaxis for the winter, what abx would you want to avoid using in thier rescue pack and why?
clarithromycin - becuase is another macrolide so use amoxicillin or doxycycline
what non-drug treatment can be used in COPD exacerbations?
positive expiratory pressure helps sputum clearance
what are the options for drug treatment in OCPD exacerbations in hosp and community?
- SAMA/SABA - withhold LAMA if SAMA given
- hospitalised - pred + other therapies (aminophylline, O2)
- community - only give pred if sevre breathlessness
why do you not give SAMA and LAMA at same time?
muscarininc SE be too much
how long do SABA work for? Name 2 examples
4 hours
salbutamol, terbutaline
how long do LABAs work for? Give 3 examples
salmeterol, vilanterol, formoterol
what are the cautions around SABAs/LABAs?
- caution in diabetes, can cause DKA especially after IV
- cause hypokalaemia, increase risk of QT prolongation, increased risk arrhythmias
alongside SABA/LABA what other drugs also increase risk of QT prolongation?
corticosteroids, diuretics, theophylline, citalopram, escitalopram
what interaction should you look out for with SABAs and LABAs (narrow TI drug)?
digoxin - increased risk of digoxin toicity due to hypokalaemia
what are the muscarininc side effects?
constipation, dry mouth, dry eye, increased ocular pressure (report halos or blurred vision)
name 5 ICS
what one is given OD?
how many times are the others given?
beclometasone, budesonisde, ciclesonide, fluticasone, mometasone
all BD except ciclesonide which is OD
what ICS must be prescribed by brand and why?
Qvar and Kalhale - this is bcause these have extra fine particles so 2x strogner than other inhalers such as clenil
what monitoring in children is needed if on prolonged ICS?
height and weight as can stunt growth - refer to paediatrician if stunted growth suspected
what are the SE of ICS?
- taste and voice aleration
- sore mouth - oral thrush
- paradoxical bronchospasam
