Asthma & COPD Treatment Flashcards
What is 1st line tx for asthma according to GINA 2019?
reliever
low dose budesonide/formoterol PRN (provides relief just as quickly as SABA)
alt: SABA and low dose ICS at the same time
What are 2nd-5th line tx options for asthma according to GINA 2019?
2nd line: low dose ICS prn or daily alt LTRA
3rd line: daily low dose ICS/LABA alt ICS+LTRA
4rth line: daily med dose ICS/LABA alt +/- tiotropium or LTRA
5th line: daily high dose ICS/LABA alt +/- OCS
ICS AE
Sore mouth, sore throat, dysphonia, oral thrush (can be reduced by rinsing mouth or using spacer).
SABA/LABA AE
Nervousness, tremor, tachycardia, palpitations.
SAMA/LAMA AE
Dry mouth, metallic taste; mydriasis and glaucoma if released into eye.
What is used to treat asthma in children?
SABA PRN, ICS+/-LABA maintenance, tiotropium adjunct
What is used to treat COPD in patients with:
0-1 exacerbations
no hospitalizations
mMRC 0-1
SABA or SAMA PRN
GOLD Group A
What is used to treat COPD in patients with:
0-1 exacerbations
no hospitalizations
mMRC 2-4
LAMA or LABA
GOLD Group B
What is used to treat COPD in patients with:
>2 exacerbations
hospitalizations
mMRC 0-1
LAMA
GOLD Group C
What is used to treat COPD in patients with:
>2 exacerbations
hospitalizations
mMRC 2-4
LAMA or LAMA/LABA or ICS/LABA or ICS/LAMA/LABA
GOLD Group D
What are tx options for COPD patients symptomatic despite ICS/LAMA/LABA?
theophyline
roflumilast
n-acetylcysteine
What are tx options for asthma patients symptomatic despite optimizing inhalers?
montelukast theophyline sodium cromoglycate omalizumab mepolizumab, benralizuman, reslizumab
How are asthma exacerbations treated?
SAMA/SABA
PO/IV Corticosteroids (Prednisone x7-14d)
NO antibiotics
How are COPD exacerbations treated?
SAMA/SABA
Corticosteroids (Prednisone x5d)
Antibiotics if on ventilator or 2 of: dyspnea, sputum, purulence: Amox, Doxy, Septra (consider others if >4 exacerabations/yr, may use azithro preventatively)
mMRC dyspnea scale
dyspnea with 0-strenuous exercise 1-hurrying or walking uphill 2-walking slower than normal 3-walking 100m/few min 4-dressing, unable to leave house used for COPD
Drugs in each class used in asthma
SABA: salbutamol, terbutaline SAMA: ipratropium LABA: formoterol, salmeterol, vilanterol LAMA: tiotropium ICS: beclomethasone, budesonide, ciclesonide, fluticasone, mometasone
Drugs in each class used in COPD
SABA: salbutamol, terbutaline
SAMA: ipratropium
LABA: formoterol, INDACATEROL
LAMA: tiotropium, GLYCOPYRRONIUM, ACLIDINIUM, UMECLIDINIUM
ICS: beclomethasone, budesonide, ciclesonide, fluticasone, mometasone
What are the 4 Qs in the GINA assessment for asthma control?
In the past 4 weeks have you had: -daytime sx more than 2/wk -night waking due to sx -reliever needed more than 2/wk -activity limitation due to sx 0=well controlled 1-2=partly controlled 3-4=uncontrolled
A well controlled asthmatic should only need how many canisters of SABA per year
1-2 salbutamol MDI
2-4 terbutaline DPI
once daily corticosteroids should be dosed at what time in children
in the morning to minimize HPA suppression (sx include growth suppression)
