Asthma management Flashcards
What is the non pharmaceutical response to an acute asthma attack
ITU/HDU
Ventilation
ECCO2R
Chest drain if pneumothorax
What is the non pharmaceutical response to chronic asthma
Asthma action plan - patient education/ Inhaler technique Vaccines Allergic avoidance Physiotherapy Smoking cessation Bronchial Thermoplasty
What is the pharmaceutical drugs administered for asthma
B2 agonist Steroids Anti Muscarinic Magnesium Oxygen
What drugs need to be avoided for asthmatics
B blockers
NSAIDS/ Aspirin
sedatives/ strong opiates
How do Steroids work in treating asthma
bind to an intracellular receptor causing changes to gene expression etc. –
changes gene expression of the cell away from inflammation, also prevent inflammatory cells from moving from the blood into the airways
How do B2 agonist work in the treatment of asthma
work by binding to the B2 adrenaline receptor causing the muscle to relax
Why is asthma therapy best delivered through inhalation
- Bypass first pass metabolism = FASTER EFFECT
- Minimal systemic exposure = LOCALISED EFFECT
- Delivery directly to the target organ = EFFECTIVE
- Small does is given = ADVERSE EFFECTS ARE LESS SEVERE
What is the three different types of inhalers
• Metered dose inhalers: need co-ordination
• Spacers: easier to take and less oro-pharyngeal
deposition
• Dry powder inhalers: less co-ordination required
What medication is used to relive the effects of asthma and taken as required
Short acting B2 agonists (SABA)
What is examples of SABA
- Salbutamol: In metered dose inhalers or dry powdered
inhalers - Terbutaline: In dry powdered inhalers
What is the short term side effects of SABA
- Tremor
- Cramp
- Headache
- Flushing
- Palpitations
- Angina
What is the long term side effects of SABA
Dysphonia - difficulty speaking
oral thrush
What medication is taken daily as to prevent asthma
Inhaled Corticosteroids (ICS)
What is examples of Inhaled Corticosteroids (ICS) taken in the treatment for asthma
- Beclomethasone
- Budesonide
- Fluticasone
- Ciclesonide
- Mometasone
What are side effect for Inhaled Corticosteroids (ICS)
minimal
What other drug therapies work for asthma treatment
§ ICS and Long Acting B2 Agonists (LABA) = combined inhaler medication.
§ Leukotriene Receptor Antagonist (LTRA) = More effective in those who are allergic
§ Theophyline = Non-specific inhibitor but has many severe side effects
§ Inhaled Long-acting anti-muscarinic (LAMA)
§ Oral B2 agonists = very unpleasant side effects
§ Long term oral steroids = pretty serious, can have some severe side effects
What is the side effect of Inhaled Long-acting anti-muscarinic (LAMA
can give you dry mouth, headaches
What drug treatment is expensive and seen as a last resort in the treatment of asthma
Immune suppressive drugs
How does Immune suppressive drugs work in the treatment of asthma
contain monoclonal antibodies against IgE/cytokines responsible for inflammatory reactions
If child has the symptoms of asthma but no wheeze is present what is the alternative diagnosis’s
o Bronchitis – infection of bronchi – wet sounding cough –bacteria intake
makes mucociliary escalator stop working.
o Pertussis – whooping cough – patient vomits, haematoma o Habitual cough – single loud cough in 8-12 year old
o Tracheomalacia – lifelong, loud cough
What is the paediatric treatment for asthma upon diagnosis
Give SABA and start on low dose Inhaled corticosteriods (max dose 800MG) -review after 2 months
What is the further treatment steps for paediatric asthma
Add on preventers LABA/ LTRA and if needed increase ICS
What is the mechanism for LTRA
combination of both bronchodilator and anti-inflammatory effects
What preventers works best in paediatric asthma
LABA
What non pharmaceutical interventions take place in paediatric asthma
Stop tobacco smoke exposure, remove environmental triggers
In paediatric asthma how must LABA be administrated
must be given with ICS and can only be used as a fixed dose inhaler
What is the best choice treatment in paediatric asthma
ICS - minimal side effects
What is the only LTRA drug that can be administrated in paediatric asthma
montelukast
What is the two delivery system in the treatment of paediatric asthma
- MDI/spacer – USE A SPACER over nebuliser
- Dry powder device (under 8s cannot use them)
How do measure control in paediatric asthma
With SANE • Short acting beta agonist/week • Absence school/nursery • Nocturnal symptoms/week • Excertional symptoms/week
What is the steps in finding appropriate treatment in paediatric asthma
Step 1: Short acting beta agonists (SABA) – NEVER GIVEN ORALLY
Step 2: Regular preventer = low dose inhaled corticosteroids - MAX DOSE 800MG Step 3: Add on preventers (either LABA or LTRA) or increase ICS dose… LABA proven to work better in kids than LTRA
Step 4: Experimental medicine
How does paediatric treatment of asthma differ from adult treatment
Max dose ICS 800 microg
No oral B2 tablet
LTRA first line preventer in <5s
How does steroid treatment differ between acute or chronic asthma
acute - oral steroids
chronic - Inhaled steroids
What is the licensing of dry powder devices
Licensed in over 5s, under 8s cannot use them
What is bronchial thermoplasty
delivery of controlled, therapeutic radiofrequency energy to the airway wall, thus heating the tissue and reducing the amount of smooth muscle present in the airway wall
