Asthma management Flashcards
Give a summary of the treatment ladder from BTS
- Add a short-acting beta 2 agonist inhaler as required for infrequent wheezy episodes
- Add a regular low dose inhaled corticosteroid
- Add LABA inhaler. Continue the LABA only is the patient has a good response
- Add a leukotriene receptor antagonist (Montelukast), oral beta-2 agonist, theophylline or LAMA (tiotropium)
- Increase the inhaled corticosteroid to a ‘high dose.’ Combine additional treatments from step 4. Refer to specialist
- Add low dose oral prednisolone
Give a summary of the treatment ladder from NICE
- SABA
- SABA + low-dose ICS
- SABA + low-dose ICS + LTRA
- SABA + low-dose ICS + LABA
Continue LTRA depending on patient’s response - MART regime
- MART + moderate-ICS
- MART + high-ICS/theophylline, LAMA
- Refer to specialist
What is Maintenance and Reliever therapy (MART)?
Combination of ICS and LAMA
- Use twice daily
- Use as required
What does uncontrolled asthma look like?
- 3+ days / week with symptoms
- 3+ days / week with required use of SABA for symptomatic relief
- 1+ nights / week with awakening
What does well controlled asthma look like?
No symptoms
What are the reasons for uncontrolled asthma?
- Alternative diagnoses
- Lack of adherence
- Bad inhaler technique
- Smoking
- Occupational exposures
- Psychosocial factors
- Seasonal factors
What do beta 2 adrenoreceptor agonists do?
Relax bronchial smooth muscle
Give an example of a SABA
- Salbutamol
- Terbutaline
Give an example of a LABA
- Salmeterol
- Formoterol
What do corticosteroids do?
Decrease bronchial mucosal inflammation by increasing cAMP levels
Give an example of an inhaled corticosteroid
- Beclometasone
- Budesonide
- Fluticasone
- Ciclesonide
- Mometasone
Give an example of an oral corticosteroid
Prednisolone
What does aminophylline do?
Inhibits phosphodiesterase to decrease bronchoconstriction by increasing cAMP levels
What are the risks with aminophylline?
It has a narrow therapeutic ratio causing:
- Arrhythmias
- GI upsets
- Fits
What should you routinely check with aminophylline?
- Check levels
- Do ECGs
- Check plasma levels after 24hrs if IV therapy has been used
What do leukotriene receptor antagonists do?
Block the effects of cysteinyl leukotrienes in the airways by antagonising the CystLT1 receptor
Give an example of a leukotriene receptor antagonist
Monteleukast
What is a low, moderate and high ICS dose?
Low = ≤ 400 micrograms Moderate = 400-800 micrograms High = >800 micrograms
