Asthma Management Flashcards
What lifestyle management for chronic asthma?
Quit smoking
Weight loss if obese
Avoid precipitants
Teach to use PEF meter and monitor twice a day
Education about self-management according to symptoms or PEF
Emergency action plan
Relaxed breathing
First step?
SAB2A as required for symptom relief
Salbutamol
Second step?
SABA + low dose ICS e.g. beclametasone
if not controlled on SABA or symptoms 3 or more times a week or night-time waking
Third step?
SABA + low dose ICS + Lecutriene receptor antagonist LTRA -
Fourth step?
SABA + low dose ICS + LABA (salmeterol)
Continue LTRA depending on patients response to it
Fifth step?
SABA ± LRTA
Switch ICS/LABA for a maintenance and reliever therapy (MART) that includes low dose ICS
What is MART?
Maintenance and reliever therapy:
Form of combined ICS and LABA treatment in a sing inhaler containing both ICS and fast acing LABA - used for both daily maintenance and relief of symptoms as required.
e.g. formoterol
Sixth step?
SABA ± LRTS + medium dose ICS MART
or consider changing back to a fixed dose of moderate-dose ICS and a LABA separate
Seventh step?
SABA ± LRTA + one of:
Increase ICS to high dose (only as fixed dose not MART)
Trial of additional drug: LAMA (ipratropium/tiotropium) or theophylline
Seek expert advice
(add regular oral prednisone)
How do beta-2 agonists work? Examples? SE?
Relax bronchial smooth muscle by increasing cAMP
Act within minutes
SABA - salbutamol, LABA - salmetrol
SE: tachyarrhythmias, hypokalameia, tremor, anxiety
How do corticosteroids work? What advice should you give? SE?
Minimise systemic effects
Act over days to reduce bronchial mucosal inflammation
Rinse mouth after inhaled steroids to prevent candidiasis
SE: pancreatitis, candidiasis, PUD, osteoporosis, CUshin’gs
Papilloedema, cataracts, increased susceptibility to infection
Can cause fever and raised WCC
How does theophylline work? SE?
inhibits phosphodiesterase thus reducing bornchoconstriction by increasing cAMP levels
Prophylaxis at night
Narrow therapeutic ratio causing arrhythmias, GI upset and fits in toxic range
How do LRTAs work?
Block the effects of leukotrienes in the airways - prevent bronchial smooth muscle contraction
How do anticholinergic work?
IPtratropium (shorter duration of action) and tiotropium
May reduce muscle spasm syndergistically with beta2 agonists.
What are low moderate and high dose ICD?
400 or less budesonide = low
400–800 = moderate
>800 high
