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RESP - 1 > Asthma Management > Flashcards

Asthma Management Flashcards

1
Q

What drugs should be avoided in asthmatics?

A 
Beta blockers
NSAIDs
Aspirin
Sedatives
Strong opiates
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2
Q

Why is a MDI + spacer better than an MDI alone?

A

Low oropharyngeal deposition
Reduced bad taste
Reduced candidiasis
Reduced cold-freon effect in some

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3
Q

What are the aims of management in asthma?

A 
No day time symptoms
No night awakening due to asthma 
No need for rescue meds
No asthma attacks
No limitations on physical activity
Minimal SEs from treatment
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4
Q

Asthma treatment in adults:

STEP 1 - newly diagnosed asthma

A

SABA

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5
Q

Asthma treatment in adults:

STEP 2

A

Not controlled on prev step or newly diagnosed asthma with symptoms >=3/week or night time waking

SABA + low dose ICS

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6
Q

Asthma treatment in adults:

STEP 3

A

SABA + low dose ICS + LTRA

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7
Q

Asthma treatment in adults:

STEP 4

A

SABA + low dose ICS + LABA

Continue LTRA depending on response to LTRA

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8
Q

Asthma treatment in adults:

STEP 5

A

SABA +/- LTRA

Switch ICS/LABA for maintence and reliever therapy (MART) that includes low dose ICS

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9
Q

Asthma treatment in adults:

STEP 6

A

SABA +/- LTRA + medium dose ICS MART

Or consider changing back to fixed dose of moderate dose ICS and separate LABA

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10
Q

Asthma treatment in adults:

STEP 7

A

SABA +/- LTRA + 1 of:

  • Increase ICS to high dose (fixed dose regimen)
  • Trial of additional drug, e.g. LAMA or theophylline
  • Seek advice from healthcare professional with expertise in asthma
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11
Q

What is MART?

A

Maintenance and reliever therapy - form of combined ICS and fasting acting LABA used for maintenance and as needed as a reliever

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12
Q

What is considered low dose ICS in adults?

A

<=400mcg budesonide or equivalent

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13
Q

What is considered moderate dose ICS in adults?

A

400-800mcg budesonide or equivalent

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14
Q

What is considered high dose ICS in adults?

A

> 800 mcg or equivalent

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15
Q

What are e.g.s of SABAs?

A

Salbutamol (MDI)

Terbutaline (PDI)

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16
Q

What AEs are associated with SABAs?

A

Tremor, cramp, headache, flushing, palpitations, angina

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17
Q

Give e.g.s of ICSs

A

Bedomethasone
Budesonide
Flucticasone

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18
Q

What are AEs associated with ICS?

A

Dysphonia

Oesophageal candidiasis

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19
Q

Give e.g.s of LABAs

A

Formeterol

Salmeterol

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20
Q

What are the two LTRAs?

A

Montelukast or zarfirlukast

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21
Q

Who are LTRAs most effective in?

A

Those who are highly allergic

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22
Q

What is theophylline?

A

Non-specific phosphodiesterase inhibitor and adenosine receptor antagonist

It is a weak bronchodilator

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23
Q

What are SEs of theophylline?

A 
Anorexia
Headache
NV
Malaise
Nervousness
Ab discomfort
Insomnia
Tachycardia
Tachyarrhythmia 
Convulsions

NARROW THERAPEUTIC INDEX

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24
Q

Give an e.g. of a LAMA

A

Tiotropium bromide

25
Q

How do LAMAs help in asthma management?

A

Antagonist M3 muscarinic ACh receptor in bronchial smooth muscle

26
Q

What SEs are associated with LAMAs?

A

Dry mouth
GI upset
Headaches

Rarely angle closure glaucoma

27
Q

If a patient with asthma has to go on long term oral steroids what steroid is usually used?

A

Prednisolone at lowest possible dose

28
Q

What other drugs may be started by specialists to treat treatment resistant asthma?

A

Omalizumab
Mepolizumab
Immunosupressives, e.g. methotrexate, cyclosporin (last resort)

29
Q

What is omalizumab?

A

Monoclonal Ab against IgE

30
Q

What is mepolizumab?

A

Monoclonal Ab against IL-5

Given to those with poor asthma control with eosinophilia

31
Q

What may be involved in the non-pharmacological management of asthma?

A 
Advice re inhaler use
Smoking
cessation 
Flu/pneum vaccine
Co-morbs
Allergen avoidance
32
Q

How is acute asthma (mild-moderate) treated in adults?

A

Oral prednisolone 7 day

Use SABA up to 2hrly

33
Q

How is a severe acute asthma attack managed in adults?

A 
Admit
Oral/IV steroids
Neb bronchodilators (salbutamol/ipatropium)
Oxygen 
Consider ABG
IV MgSO4 if no response 
Antibiotics if req.
Lifethreatening --> ITU (may need intubation, ventilation, ECCO2R may be lifesaving)
34
Q

What mnemonic is used to measure control of asthma in children?

A 
SANE
SABA/wk
Absence from school/nursery 
Nocturnal symptoms/wk
Exertional symptoms/wk
35
Q

Asthma management in those aged 5-16 years:

STEP 1 - newly diagnosed asthma

36
Q

Asthma management in those aged 5-16 years:

STEP 2

A

Not controlled on prev step/newly diagnosed asthma with symptoms >=3x/wk or night time waking

SABA + paediatric low dose ICS

37
Q

Asthma management in those aged 5-16 years:

STEP 3

A

SABA + paediatric low dose ICS + LTRA

38
Q

Asthma management in those aged 5-16 years:

STEP 4

A

SABA + paediatric low dose ICS + LABA

STOP LTRA if it has not helped

39
Q

Asthma management in those aged 5-16 years:

STEP 5

A

SABA + switch ICS/LABA for maintenance + reliever therapy (MART) that includes low dose paediatric ICS

40
Q

Asthma management in those aged 5-16 years:

STEP 6

A

SABA + paediatric moderate dose ICS MART OR consider changing back to fixed dose of a moderate dose ICS and separate LABA

41
Q

Asthma management in those aged 5-16 years:

STEP 7

A

SABA + 1 of:

  • Increase ICS to paediatric high dose (either as part of fixed dose regimen or MART)
  • Trial additional drug, e.g. theophylline
  • Seek advice
42
Q

Asthma management in those aged <5 years:

STEP 1

43
Q

Asthma management in those aged <5 years:

STEP 2

A

SABA + 8 week trial of paediatric moderate dose ICS

After 8w stop + monitor child’s symptoms - if did not resolve during trial review + consider alt diagnosis, if symptoms resolved then reoccur within 4 weeks restart ICS at paediatric low dose as first line maintenance therapy, if symptoms resolved but reoccured beyond 4 weeks of stopping ICS, repeat 8 week trial of paediatric moderate dose ICS

44
Q

Asthma management in those aged <5 years:

STEP 3

A

SABA + low dose ICs + LTRA

45
Q

Asthma management in those aged <5 years:

STEP 4

A

Stop LTRA and refer to paediatric asthma specialist

46
Q

What is considered paediatric low dose ICS?

A

<=200mcg budesonide or equivalent

47
Q

What is considered paediatric moderate dose ICS?

A

200-400mcg budesonide or equivalent

48
Q

What is considered paediatric high dose ICS?

A

> 400 budesonide or equivalent

49
Q

What advice can you give to parents about what they can possibly do to improve their child’s asthma?

A

Stop tobacco exposure

Remove environmental triggers

50
Q

What patients with acute asthma should have an ABG?

A

Those with O2 sats <92%

51
Q

When might you do a CXR in acute asthma?

A

Life-threatening asthma
Suspected pneumothorax
Failure to respond to treatment

52
Q

What patients should be admitted to hospital if they are having an acute asthma attack (adults)?

A 
Life-threatening/severe features
Prev. near fatal asthma attack 
Failure to respond to initial treatment
Pregnant
An attack occurring despite already being on oral corticosteroids
53
Q

What oxygen should those admitted with an asthma attack be given?

A

15L supplemental via non-rebreathe mask (can be titrated down when they are able to maintain an SpO2 of 94-98%)

54
Q

How should SABA be given in acute asthma?

A

If mild/moderate - pMDI/oxygen driven nebuliser

Life-threatening/severe - nebulised

55
Q

What corticosteroid and what dose of it should be given to adults having acute asthma?

A

40-50mg prednisolone PO for at least 5 days

56
Q

What additional drugs may be given to those with severe/life-threatning asthma?

A

Ipratropium bromide
IV magnesium sulphate
IV aminophylline

If fail to respond to this –> ITU for intubation, ventilation and possibly ECMO

57
Q

What is the criteria for discharge of adults with acute asthma?

A

Stable on discharge meds for 12-24h
Inhaler technique checked and recorded
PEF >75% best/predicted

58
Q

How is mild-moderate acute asthma in children managed?

A

Bronchilator therapy - SABA (one puff every 30-60s up to max of 10 puffs) –> if symptoms not controlled send to hospital
Steroids - 3-5 days (pred 1-2mg/kg od)

RESP - 1 (27 decks)

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