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ASTHMA DIAGNOSIS AND MANAGEMENT Flashcards

1
Q

1st line treatment for asthma >12 years newly diagnoses

A

low dose ICS/formoterol inhaler (eg. Symbicort®, Fostair®, DuoResp®, Fobumix®, Luforbec®, and Wockair) as AIR therapy - as required

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2
Q

If asthma uncontrolled after 1st line in >12 years? what’s the next line therapy

A

Low dose ICS/formoterol (eg.Symbicort®, Fostair®, DuoResp®, Fobumix®, Luforbec®, and Wockair) as MART therapy - prescribed intervals

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3
Q

If asthma uncontrolled after 2nd line in >12 years? what’s the next line therapy

A

Moderate ICS/formeterol (eg.ISymbicort®, Fostair®, DuoResp®, Fobumix®, Luforbec®, and Wockair) as MART therapy

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4
Q

If asthma uncontrolled after 3rd line in >12 years? what’s the next line therapy

A

Check FeNO levels and blood eosinophil count (specialist referral). If either of these are raised try LTRA or LAMA in addition to MART therapy for 8-12 weeks. if still uncontrolled refer to specialist

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5
Q

define uncontrolled asthma

A

exacerbation needing ICS or frequent regular symptoms eg. reliever inhaler > 3 days a week or at night, waking > 1 times in a week

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6
Q

Moving patients from current treatment to new treatment?

A

SABA only - ICS/formoterol AIR therapy whether asthma controlled or not

If asthma uncontolled and ..
Low dose ICS any combination of therapies = Low dose MART therapy
Moderate dose ICS combination = Moderate dose MART therapy

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7
Q

1st line treatment for asthma 5-11 years newly diagnoses

A

BD paeds low dose ICS/SABA when required

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8
Q

managing asthma for those who MART therapy is appropriate

A

Paeds low dose MART (off label)
Dose can be increased to moderate paeds if asthma uncontrolled
Then refer to specialist

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9
Q

managing asthma for those who MART therapy is NOT appropriate

A

try LTRA eg. monteleukast added to BD low dose ICS 8-12 weeks
if still unmanaged offer paeds low dose ICS/LABA +/- LTRA when required
If still uncontrolled all 3 but moderate
refer to specialist if still uncontrolled

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10
Q

1st line treatment for asthma <5 years newly diagnoses

A

Low dose paeds ICS + SABA when required trial for 8-12 weeks

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11
Q

1st line treatment for asthma <5 years newly diagnoses fails. What happens next?

A

check adherence / inhaler technique, environmental factors, alternative digonisis then refer if symptoms dont resolve
OR
if symptooms resolve - stop ICS + SABA and if symptoms come back build back up ICS low - moderate dose, then LTRA, then refer if needed

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12
Q

Asthma diagnosis >16 years

A

Get clinical history - symptoms, triggers, family history
Objective tests:
1. Eosinophils / FeNo test: >50ppm
2. Spirometry: FEV1 increase is 12% or more from baseline (or if the FEV1 increase is 10% or more of the predicted normal FEV
3. Peak flow BD for 2 weeks: PEF veriabilit >20%
4. Bronchial challenge (secondary care)

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13
Q

Asthma diagnosis 5-11 years

A

Get clinical history - symptoms, triggers, family history
Objective tests:
1. Eosinophils / FeNo test: >35ppm
2. Spirometry: FEV1 increase is 12% or more from baseline (or if the FEV1 increase is 10% or more of the predicted normal FEV
3. Peak flow BD for 2 weeks: PEF veriabilit >20%
4. Bronchial challenge (secondary care)

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14
Q

Asthma diagnosis <5 years

A

try with ICS and review
When patient gets to 5 years, perform objective tests

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15
Q

Symptoms of asthma

A

SOB
Coughing
Wheezing
tight chest

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16
Q

ICS dosages for >12 years
Low dose Beclomethasone - standard particle meter dose / dry powder

A

200 - 500mcg per day in 2 doses

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17
Q

ICS dosages for >12 years
moderate dose Beclomethasone - standard particle meter dose / dry powder

A

600-800 mcg per day in 2 doses

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18
Q

ICS dosages for >12 years
high dose Beclomethasone - standard particle meter dose / dry powder

A

1,000-2,000mcg per day in 2 doses

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19
Q

ICS dosages for >12 years
low dose betamethasone of extra fine particles

A

100-200mcg per day in 2 doses

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20
Q

ICS dosages for >12 years
moderate dose betamethasone of extra fine particles

A

300-400mcg per day in 2 doses

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21
Q

ICS dosages for >12 years
high dose betamethasone of extra fine particles

A

500-800mcg per day in 2 doses

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22
Q

examples of betamethasone extra fine particles brands

A

Qvar, Luforbec, Kelhale and Fostair

These are more potent than standard ICS particle size

23
Q

ICS dosages for >12 years
low dose budesonide

A

200-400mcg per day in 1-2 doses

24
Q

ICS dosages for >12 years
moderate dose budesonide

A

600-800mcg per day in 1-2 doses

25
Q

ICS dosages for >12 years
high dose budesonide

A

1,000-1,600mcg per day in 2 doses

26
Q

ICS dosages for >12 years
low dose ciclesonide

A

80-160mcg daily in 1 dose

27
Q

ICS dosages for >12 years
moderate dose ciclesonide

A

240-320mcg daily in 1-2 doses

28
Q

ICS dosages for >12 years
high dose ciclesonide

A

400-640mcg daily in 2 doses

29
Q

ICS dosages for >12 years
low dose fluticasone propionate (excluding seffalair spiromax)

A

100-200mcg daily in 2 doses

30
Q

ICS dosages for >12 years
moderate dose fluticasone propionate (excluding seffalair spiromax)

A

300-500mcg daily in 2 doses

31
Q

ICS dosages for >12 years
high dose fluticasone propionate (excluding seffalair spiromax

A

600-1,000mcg daily in 2 doses

32
Q

Licencing of fluticasone propionate brands Flixotide Evohaler and Flixotide Accuhaler

A

Flixotide Evohaler and Flixotide Accuhaler are licensed up to 2,000 micrograms per day (in 2 divided doses) for adults >17 with severe asthma

33
Q

active ingredients in Seffalair Spiromax

A

Seffalair Spiromax is a combination product containing fluticasone propionate and salmeterol.

The manufacturer’s SPC states the delivered dose of Seffalair Spiromax is different from other salmeterol/fluticasone containing products.

34
Q

ICS dosages for >12 years
moderate dose fluticasone furoate

A

100mcg as 1 dose

35
Q

ICS dosages for >12 years
high dose fluticasone furoate

A

200mcg daily in 1 dose

36
Q

fluticasone furoate brand

A

Relvar Ellipta (fluticasone furoate with vilanterol

37
Q

converting fluticasone furoate to propionate

A

fluticasone furoate 100 micrograms once daily is approximately
equivalent to fluticasone propionate 500 micrograms a day (in 2 divided doses

38
Q

ICS dosages for >12 years
low dose mometasone dry powder inhaler

A

200mcg daily in 1 dose

39
Q

ICS dosages for >12 years
moderate dose mometasone dry powder inhaler

A

400mcg daily in 1-2 doses

40
Q

ICS dosages for >12 years
high dose mometasone dry powder inhaler

A

600-800mcg daily in 2 doses

41
Q

ICS dosages for >12 years
low dose mometasone inhalation capsules

A

80mcg daily in 1 dose

42
Q

ICS dosages for >12 years
moderate dose mometasone inhalation capsules

A

160mcg daily in 1 dose

43
Q

ICS dosages for >12 years
low dose mometasone inhalation capsules

A

320mcg daily in 1 dose

44
Q

ICS dosages for 5-11 years
Pediatric Beclomethasone standard metered dose

A

Low: 100-200mcg daily in 2 doses
Moderate: 300-400mcg daily in 2-4 doses
High: 500-800mch daily in 2-4 doses

45
Q

ICS dosages for 5-11 years
Pediatric Beclomethasone extra fine particle size

A

Low: 100mcg daily in 2 doses
Moderate: 150-200mcg daily in 2 doses
High: 300-400mcg daily in 2 doses

46
Q

ICS dosages for 5-11 years
Pediatric budesonide dry powder inhaler

A

Low: 100-200mch daily in 2 doses
Moderate: 150-200mcg daily in 2 doses
High: 300-400mcg daily in 2 doses

47
Q

ICS dosages for 5-11 years
Pediatric ciclesonide metered dose inhaler

A

Low: 80mcg in 1 dose
Moderate: 160mcg daily in 1-2 doses
High: 240-320mcg daily in 2 doses

48
Q

ICS dosages for 5-11 years
Pediatric Fluticasone propionate metered dose dry powder

A

Low: 100mcg in 2 doses
Moderate: 150-200mcg daily in 2 doses
High: 250-400mcg daily in 2 doses

49
Q

life threatening asthma exacerbation

A

Adults and children cyanosis, drowsy, exhaustion, poor respiratory effort, confusion, oxygen saturation on air < 92%; hypotension; PEF <33% best or predicted; and/or ‘silent chest’.

50
Q

acute severe /moderate asthma exacerbation

A

Adults: inability to complete sentences in one breath; oxygen saturation <92%; respiratory rate >25 breaths pm; pulse rate >110 beats pm; and PEF >33–50% best or predicted.
Children: too breathless to talk or feed; use of accessory neck muscles; oxygen saturation <92%; PEF >33–50% best or predicted; pulse rate increased

51
Q

managing exacerbation of asthma

A
  1. Administer oxygen
    controlled in adults and high-flow in children aiming 94-98% saturation
  2. nebulized salbutamol or inhaler then ipratropium via nebulizer is still uncontrolled
  3. oral prednisolone immediately
52
Q

doses of salbutamol in asthma exacerbation in adults and children

A

Adult: 4 puffs then 2 puffs every 2 mins up to 10 puffs
Children: 1 puff every 30-60seconds every 10-20mins
OR 5 mg via nebulizer if aged over 5 years or 2.5 mg if aged 2–5 years

53
Q

doses of ipratropium in asthma exacerbation in adults and children

A

0.5 mg for adults or 0.25 mg for children aged 2–12 years)

54
Q

Doses of prednisolone in asthma exacerbation in different age groups

A

40 mg to 50 mg for >16 years OD for 5 days
30 mg to 40 mg for 6–15 years OD for 3-5days
20 mg for 2–5 years OD for 3-5days
10 mg for < 2 years OD for 3-5 days

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