Asthma Management Flashcards
How does the management of asthma differ from the management of COPD?
Asthma:
Reversible airway obstruction, typically triggered by allergens or irritants.
Treatment focuses on inhaled corticosteroids (ICS), bronchodilators (SABA/LABA), and leukotriene modifiers.
Asthma management is based on symptom control, with stepwise escalation in treatment.
Peak flow monitoring and symptom tracking are essential for adjusting therapy.
COPD:
Irreversible airway obstruction, primarily caused by smoking.
Management focuses on long-acting bronchodilators (LABA/LAMA), inhaled corticosteroids (ICS) for those with frequent exacerbations, and oxygen therapy for advanced disease.
Emphasis on symptom relief, preventing exacerbations, and pulmonary rehabilitation.
How do you assess the severity of acute asthma?
Clinical features:
Mild: Able to speak in full sentences, normal oxygen saturation, PEF > 70% of predicted value.
Moderate: Shortness of breath, use of accessory muscles, PEF 50-70% of predicted value, tachypnea, and tachycardia.
Severe: Inability to speak in full sentences, cyanosis, PEF < 50% of predicted value, hypoxemia, use of accessory muscles.
Life-threatening: Silent chest, exhaustion, confusion, and severe hypoxemia (oxygen saturation < 92%).
What is the clinical management of acute asthma?
Mild to moderate exacerbation:
Short-acting beta-agonist (SABA) (e.g., Salbutamol) via nebulizer or MDI (metered-dose inhaler).
Oxygen therapy: Target oxygen saturation of 94-98%.
Systemic corticosteroids (e.g., prednisolone) for anti-inflammatory action.
Severe exacerbation:
High-dose SABA and ipratropium (SAMA) every 20 minutes for the first hour.
Systemic corticosteroids (oral or IV).
Oxygen therapy and IV fluids if needed.
Consider intravenous magnesium sulfate for severe cases unresponsive to treatment.
Life-threatening:
Intubation and mechanical ventilation may be needed.
Close monitoring and intensive therapy in an ICU setting.
What is the stepwise approach to the management of asthma based on the Scottish Intercollegiate Guidelines Network (SIGN) and British Thoracic Society (BTS) guidelines?
Step 1: SABA (short-acting beta-agonist) as needed for intermittent symptoms.
Step 2: Add low-dose inhaled corticosteroids (ICS) if symptoms persist.
Step 3: Add LABA (long-acting beta-agonist) if asthma is not controlled on ICS alone.
Step 4: Increase ICS dose to medium dose and add LABA (if not already).
Step 5: Consider high-dose ICS and additional treatments such as leukotriene receptor antagonists (LTRA) or theophylline.
Step 6: Add oral corticosteroids for severe, persistent symptoms that are difficult to control.
What are the classes of drugs and modes of delivery used in the management of obstructive lung diseases (asthma and COPD)?
Asthma:
Bronchodilators:
SABA (e.g., Salbutamol) for relief of acute symptoms.
LABA (e.g., Salmeterol, Formoterol) for long-term control in combination with ICS.
Corticosteroids:
ICS (e.g., Budesonide, Beclometasone) for inflammation control.
Oral corticosteroids for acute exacerbations.
Leukotriene modifiers: (e.g., Montelukast) for add-on therapy.
Modes of delivery: Metered-dose inhalers (MDI), dry powder inhalers (DPI), nebulizers.
COPD:
Bronchodilators:
SABA and SAMA for quick relief of symptoms.
LABA (e.g., Formoterol, Salmeterol) and LAMA (e.g., Tiotropium) for long-term management.
Corticosteroids:
ICS for patients with frequent exacerbations.
Phosphodiesterase-4 inhibitors (e.g., Roflumilast) for severe COPD.
Oxygen therapy for patients with severe hypoxemia.
Modes of delivery: Inhalers (MDI, DPI), nebulizers, and oxygen devices (e.g., nasal cannula).
What do the different colour inhalers mean?
a) Blue for beta-agonists. b) Brown for inhaled corticosteroids (ICS). c) Green for long-acting beta-agonists. d) Yellow for anticholinergics. e) Blue and Brown for beta-agonists and ICS combination. f) Green and Brown for long-acting beta-agonists and ICS combination. g) Blue and Yellow for beta-agonists and anticholinergic combination. h) Red to keep in reserve.
