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General practice 2023 > asthma management > Flashcards

asthma management Flashcards

1
Q

signs of asthma on history

A

Hx atopy
worse in morning or at night
triggered by cold air or allergens
recurrent/seasonal

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2
Q

diagnosis of asthma on examination

A

expiatory wheeze
there may be no abnormality on examination

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3
Q

what would you not expect to see on examination for asthma

A

crackles

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4
Q

what does asthma look like on spirometry

A

obstructive pattern
FEV1/FVC is below the lower limit (usually below 70% but less in older people)

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5
Q

two key features of asthma

A

obstruction and reversibility (improved with bronchodilator)

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6
Q

technique of spirometry

A

seated, good seal, good effort, all the way out, no coughing
normal spirometry doesn’t exclude asthma

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7
Q

if there is obstruction but no reversibility

A

you might have COPD
fixed airway limitation due to long term asthma
patient has already administered maximal bronchodilator

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8
Q

good control of asthma

A

all of:
daytime symptoms <2 days per week
need for reliever <2 days per week (not including SABA prophylactically before exercise)
no limitation of activities
no symptoms during night or waking

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9
Q

partial control of asthma

A

one or two of:
daytime symptoms >2 days per week
need for reliever >2 days per week (not including SABA prophylactically before exercise)
any limitation of activity
any symptoms during night or waking

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10
Q

poor control of asthma

A

three or more of:
daytime symptoms >2 days per week
need for reliever >2 days per week (not including SABA prophylactically before exercise)
any limitation of activity
any symptoms during night or waking

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11
Q

releivers

A

usually this means short acting beta agonists (SABA): salbutamol, terbutaline (largely interchangeable)

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12
Q

preventers

A

inhaled corticosteroids (ICS)
beclomethasone, budesonide, fluticasone, ciclesonide
also for kids: oral montelukast (LTRA)

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13
Q

symptom controllers

A

long acting beta agonists LABA
formoterol (faster), salmeterol (slower), vilanterol

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14
Q

formoterol might be used

A

might be used as a releiver as well because its fast

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15
Q

ICS/LABA combination preparations

A

Symbicort (budesonide/formoterol)
seretide (fluticasone/salmeterol)
breo (fluticasone/vilanterol)

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16
Q

typical symptoms of asthma

A

dyspnoea
tightness
wheeze
cough

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17
Q

especially likely to be asthma if presenting with

A

worse at night
triggered by RTIs/exercise/cold air/allergens
relieved by bronchodilator
recurrent / seasonal
Fix asthma / personal or FHx atopy

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18
Q

what does obstructive look like on spirometry

A
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19
Q

what does restrictive pattern look like on spirometry

A
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20
Q

reversibility

A

there should be a 12% improvement in FEV1

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21
Q

reproducibility of spirometry

A

less than 150ml difference in FVC

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22
Q

does normal spirometry exclude asthma

A

no

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23
Q

good technique for spirometry

A

seated, good seal, good effort, all the way out, no coughing (esp. in first second of test)

24
Q

severity of asthma

A

mild
moderate
severe
difficult-to-treat
severe treatment resistant asthma (severe refractory asthma)

25
Q

guidelines for treatment levels for asthma

A
26
Q

MART

A

maintenance and reliever therapy in the same inhaler
different approach of using ICS-formoterol prn like a reliever as well as a preventer
to maximum of 12 puffs total daily from dry powder inhaler

27
Q

MART is indicated in patients with

A
  • frequent asthma symptoms despite ICS or ICS/LABA
  • good at perceiving airway obstruction
  • don’t overuse SABAs
28
Q

SABA relievers

A
29
Q

LABA medications

A
30
Q

ICS preventers

A
31
Q

non-steroidal preventer

A
32
Q

ICA/LABA

A
33
Q

spacers

A

use with MDIs not with dry powder inhalers
wash plastic ones before use with dish washing detergent and drip dry (do not wipe)

34
Q

DPIs and MDIs

A

equally efficacious
DPIs may not be suitable for for young children (<6) and people with severe asthma with limited inspiratory capacity

35
Q

most patients will need

A
36
Q

some patients will need

A
37
Q

few patients will need

A
38
Q

obstructive picture

A

concave
obstruction of flow butno reestriction of volume

39
Q

restrictive picture

A
40
Q

mixed picture

A
41
Q

two SABAs examples

A

salbutamol and terbutaline

42
Q

inhaled corticosteroids examples

A

beclomethhasone, budesonide, fluticasone, ciclesonide

43
Q

three LABAs examples

A

formoterol, salmeterol, vilanterol

44
Q

symbiccort contains

A

formoterol and budesonide

45
Q

seretide contains

A

fluticasone and salmeterol

46
Q

SMART theraapy

A

symbicort maintenance and. reliever therapy

47
Q

6steps of asthma management

A

assess severity
achieve best lung function
maintain best lung function (identify and avoid triggers)
optimise medications
action plan
educate and rreview regularly

48
Q

very few patients will be well managed on

A

SABA alone
it is safer to add a steroid, so few patients fall into this category where they are okay on SABA alone

49
Q

most patients will be well managed on

A

regular daily ICS (low dose)+ SABA prn
OR
budesonide(ICS)/formoterol(LABA) single inhaler prn (symbicort)

50
Q

patients who need more than ICS+SABA or symbicort

A

need to add LABA either by:
MART therapy
or
regular ICS+LABA with prn SABA

51
Q

patients who need more than MART or added LABA

A

increase MART dosage
or
increase ICS-LABA dosage

52
Q

patients who are still not controlled on medium dose MART or medium-high dose ICS+LABA with SABA

A

consider specialist treatment

53
Q

where should you start with most people

A

symbicort (good because its practical - patients only take it s needed)
OR
regular low dose ICS + SABA

54
Q

what about kids under 5

A
55
Q

what should you advise patients to do after they’ve used their steroid inhaler

A

rinse mouth out to prevent oral candidiasis

56
Q

when do you use pek expiratory flow for asthma

A

basically never
might play a role for poor perceivers of symptoms

General practice 2023 (49 decks)

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