Asthma Management

Question 1

What are the goals of therapy for asthma management?

Answer 1

Prevent and control symptoms:
* No daytime symptoms
* No night-time symptoms
* No need for rescue medication
* No limitations on activity, including excersise

Reduce the risk and frequency of asthma excacerbations
Minimise adverse effects of therapy

Question 2

What must always be done before intensifying therapy?

Answer 2

1. Check adherence
2. Check inhaler technique
3. eliminate trigger factors

Question 3

How can control be achieved in asthma management?

Answer 3

1. Increase maintenance therapy as necessery
2. Decrease maintenance therapy if well controlled for three months

Question 4

State the methods use to identify if control is achieved in asthmatic patients.

Answer 4

1. Asthma control test
2. The royal college of physicians 3 questions.
3. PEFR
4. Peak flow diary
5. Pulmanory function tests (FEV1, FVS & FEV1, FVC ratio

Question 5

Descrube the step-up treatment therapy in asthma

Answer 5

1. Short acting bronchodilator (SABA)
2. Low starting dose ICS
3. Add on LABA with low dose ICS
4. if improvement but not control, increase ICS to medium dose. if not responding to LABA consider changing for LTRA.
5. If still not controlled refer patient to specialist care.
   OR
6. Add on LAMA (tiotropium) or Theophyline (more side effects)
7. If still not controlled possible require long term oral corticosteroids or monoclonal antibody via specialist

Question 6

Specialist treatment in Asthma - biologics

Answer 6

1. Anti-IgE monoclonal antibodies:
   * omalizumab - dose dependent on weight
2. Anti-IL5 monoclonal antibodies:
   * Benralizumab or Mepolizumab in patients with severe refractory eosinophilic asthma

Question 7

AIR - anti-inflammatory reliever

Answer 7

• Formoterolol + ICS
• Symbicort

Question 8

MART maintenance and reliever therapy

Answer 8

• ICS + LABA

Question 9

Acute asthma exacerbation symptoms

Answer 9

• wheezing
• chest tightness
• coughing
• dizziness
• increased respiratory rate
• increased heart rate
• drowsiness
• confusion
• fainting
• cyanosis -blueish body colour
• unable to speak/sleep due to breathlesness

Question 10

Non-pharmacological treatment of Asthma

Answer 10

1. physical and chemical methods of reducing house dust mite levels in the home not routinley reccomended.
2. Smoking and second-hand smoke
3. Lose weight if overweight or obese
4. Breathing excersises
5. regular low to moderate intensity activity