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Respiratory > Asthma Management > Flashcards

Asthma Management Flashcards

1
Q

What is the main difference between COPD and Asthma?

A

Asthma airway obstruction is reversible but COPD airway obstruction is mainly irreversible.

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2
Q

What are the aims of asthma treatment?

A 
No day time symptoms
No wakening in the night due to symptoms
No need for "rescue medication"
No asthma attacks
No limitations on activity and normal lung function
Minimal side effects from medication
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3
Q

What are the main non-pharmacological management tools used to treat asthma?

A

Exercise
Smoking cessation (for child reduce exposure to smoke)
Weight management (no evidence in children)
Flu/Pneumococcal vaccinations
Removal/avoidance of triggers

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4
Q

What is the assessment of the severity of an asthma attack based on?

A
  • Ability to speak
  • Heart Rate
  • Respiratory Rate
  • PEF-peak expiratory flow
  • Oxygen saturation/Arterial blood gases
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5
Q

What is the most important thing to keep in mind about asthma management?

A

It is personalised for each patient.

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6
Q

What is an asthma action plan?

A

It is a comprehensive plan of what treatment to use for each stage of that patient’s asthma (personalised).

The 1st part will cover what the patients needs to do when they are well.
The 2nd part will discuss when the patient should take their reliver and how much.
The 3rd part will discuss what to do when the asthma/symptoms start to get worse.
The last part will describe what to do during an asthma attack.

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7
Q

What are the pharmacological treatments used for asthma?

A

Inhaled therapies
Oral therapies
Specialist treatments

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8
Q

What are inhaled therapies and what are they used for?

A

The are drugs including steroids that are used in an aresole or powder form so that they can be inhaled, for direct transport to the required site.
They can be used as preventers or relievers, depending on the drug contained within them.

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9
Q

What are the benefits of using and inhaler?

A
  • direct delivery
  • fast acting
  • minimal systemic exposure
  • adverse effects are less severe and less frequent
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10
Q

What are the two things to remember about LABA’s?

A

DO NOT use WITHOUT ICS (as there is an increased risk of sudden death)
Use as a fixed dose inhaler.

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11
Q

In children, how can you measure how well controlled their asthma is?

A 
SANE
Short acting beta agonist uses/week
Absence from school or nursery
Nocturnal symptoms/week
Exertional symptoms/week
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12
Q

What are the different classes of medications used?

A 
Short acting beta agonists 
Inhaled corticosteroids (ICS)
Long acting beta agonists 
Leukotriene receptor antagonists (LTRA's)
Theophyllines
Oral steroids
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13
Q

How does theophylline work?

A

It relaxes the smooth muscle around the airways.

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14
Q

What is the first step of asthma treatment in children?

A

Use of short acting Beta 2 agonist when required (this is continued through all stages) is the blue inhaler. (Salbutamol)

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15
Q

What is the second step in children’s asthma treatment?

A

Use of regular preventer, which will be a very low dose ICS or in <5 years old use a LTRA (leukotriene receptor antagonist)

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16
Q

Third step in children’s asthma treatment?

A

An add-on preventer, so a inhaled LABA (long acting beta2 agonist) BUT keep an open mind
in <5 add a LTRA
The majority of patients don’t have the best response to any of LABA, ICS or LTRA, so it depends on the patient for what is going to work.

17
Q

What is the 4th step in treating asthma in children?

A

Increase ICS dose.
Stop LABA if not helping
Consider a trail of an LTRA therapy

18
Q

5th step?

A

Increase ICS to medium dose

Consider adding SR theophylline

19
Q

What is the last step (6th) in children’s asthma treatment?

A

Continuous or frequent use of oral steroid tablet in the lowest dose.
Maintain medium ICS dose
Consider other therapies to minimise oral steroid use.

20
Q

At what point should a child be referred to specialist asthma care?

A

(Steps 5 and 6)

When the use of medium does ICS’s, SR theophylline or frequent oral steroids is required.

21
Q

How does children’s asthma treatment differ from that of an adult?

A

For <12 years old max ICS dose is 800 microg
Children are not given oral B2 tablets
LTRA is the 1st line preventer in under 5s
LAMA’s (long acting muscarinic antagonists) are not used
There are only 2 biological treatments for children but more for adults.

22
Q

When should you increase a child’s treatment to the next stage?

A

When they are using their “blue inhaler” (short acting B2 agonist, salbutamol) more than 2-3 times a week or waking more than one night a week.

23
Q

What are the adverse effects of ICS’s?

A

Slight height suppression
Oral candidiasis (oral thrush)
Adrenocortical suppression

24
Q

Give the most common LTRA used

A

Montelukast
rule of thirds (1/3 works well, 1/3 works a bit and 1/3 doesn’t work at all)
Granules can be used for reluctant toddlers.

25
Q

Why can dry powder inhalers only be given to patients >8 year old?

A

Under 8 the patient can not generate enough force to suck the medication in to the lungs.

26
Q

What treatment should you give to a child who is having an mild acute asthma attack , so has a slightly increase RR but not increased respiratory effort?

A

Give SABA via space

could also give prednisone, which is a corticosteroid

27
Q

What treatment would you give if an asthmatic child that is having a moderate acute asthma attack?

A

SABA via nebuliser and prednisone
or
SABA and ipra via nebuliser and prednisone

28
Q

What are the specialist treatments given when a child is having a severe asthma attack?

A 
IV salbutamol
IV aminophylline
IV magnesium (via neb)
IV hydrocortisone
Intubate and ventilate
29
Q

What factors are used to decide how severe an asthma attack is?

A 
RR (respiratory rate)
Work of breathing
HR (heart rate)
Oxygen saturations 
Ability to talk in complete sentences
Confusion (if confused they are likely hypoxic)
Air entry

This should be dealt with by senior specialists

30
Q

What are the stages of treatment for adults with asthma?

A

1st- use of SABA (blue inhaler) as required (this is continued through all stages)
2nd- low dose ICS (regular preventer)
3rd- add inhaled LABA to low dose ICS
4th- Increase ICS dose, stop LABA if not helping. Consider trail of LTRA, theophylline or LAMA
5th- increase ICS dose to high. Add fourth drug e.g. LTRA, theophylline, beta agonist tablet or LAMA
6th- Maintain high-dose ICS, use lowest dose oral steroids daily (consider other treatments)

31
Q

What are some specialist treatment options for adults?

A

Omalizumab (Anti-IgE) (anti-antibodies)
Mepolizumab (Anti-Interleukin-5)- interleukin-5 is a signalling molecule used in the immune system
Bronchial thermoplasty- a heat treatment that reduces that amount of thickened muscle around the airways.

32
Q

At what stage do you have to refer an adult patient to a specialist?

A

When ICS dose is increased to high or oral steroids are used frequently (daily)

33
Q

What are the characteristics of moderate acute asthma in adults?

A

Increasing symptoms

PEF >50-75% of best or predicted

34
Q

What are the features of acute severe asthma?

A 
Any one of:
PEF 33-50% of best or predicted
Respiratory rate >/= 25/min
HR>/= to 110bpm
Inability to complete sentences in one breath
35
Q

What are the features of life-threatening acute asthma?

A 
Any one of:
(clinical signs)
Altered consciousness level
Exhaustion
Arrhythmia
Hypotension
Cyanosis
Silent Chest
Poor respiratory effort
(measurements)
PEF<33% best or predicted 
Saturation of O2 <92%
PaO2<8kPa 
normal PaCO2 (4.6-6.0 kPa)
36
Q

What are the features of near-fatal acute asthma?

A 
Raised PaCO2
(and/or) requiring mechanical ventilation with raised inflation pressures
37
Q

In adults how do you treat mild/moderate acute asthma?

A

Increase inhaler use
Oral steroid
Treat/ remove trigger

38
Q

How do you treat moderate/severe acute asthma in adults?

A

Nebulisers of salbutamol or Ipratropium
Oral/IV steroid
Magnesium
Aminophylline

Respiratory (12 decks)

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