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Mustafa respiratory > Asthma management - Adults > Flashcards

Asthma management - Adults Flashcards

1
Q

What cells are responsible for the effects of asthma?

A

Th2 Cytokines - (IL-5, LT)

Eosinophils

Mast cells

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2
Q

What is the major contributor for the ari resistance of a tube?

A

The radius

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3
Q

What is the difference between occupational asthma and work-exacerbated asthma?

A

Occupational has no prior history of asthma

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4
Q

What is non-pharma management of chronic asthma?

A

Asthma Action Plan

Weight loss if ˄BMI

Vaccines – flu & pneum

Allergen avoidance

(inc. occup. Asthma)

Physiotherapy

Smoking Cessation

Bronchial Thermoplasty

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5
Q

What are the drugs used to treat acute asthma attack and chronic asthma?

A
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6
Q

What are the drugs to avoid during the treatment of asthma?

A

**β-blockers**

NSAIDS / Aspirin

Sedatives/strong opiates (unless in critical care)

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7
Q

What are the non-pharma methods of treatment of acute asthma attack?

A

ITU/HDU

Ventilation

ECCO2R

Chest drain if

pneumothorax

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8
Q

What are the benefits of inhalers?

A
  • Small dose of drugs
  • Delivery directly to the target organ (airways and lung)

•

•Onset of effect is faster

•

•Minimal systemic exposure

•

•Systemic adverse effects are less severe and less frequent

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9
Q

What are the problems associated with metered dose inhalers?

A
  • Needs co-ordination
  • Elderly, young children, unwell can’t use effectively
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10
Q

What are the benefits of spacers?

A
  • Low oro-pharyngeal deposition of aerosol
  • Reduced speed of the aerosol
  • decreases bad taste associated with oral deposition
  • reduced the risk of oral candidiasis and dysphonia with steroids
  • Reduced “cold-Freon effect” in some
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11
Q

What are the benefits associated with dry powder inhalers?

A
  • Less coordination required
  • Similar issues with deposition

Requires high inspiratory flow

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12
Q

What is defined as the complete control of asthma?

A
  • no daytime symptoms
  • no night-time awakening due to asthma
  • no need for rescue medication
  • no asthma attacks
  • no limitations on activity including exercise & normal lung function (in practical terms FEV1 and/or PEF>80% predicted or best)
  • minimal side effects from medication.

–BTS/SIGN 2016

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13
Q

What does SABA stand for?

A

Short acting beta 2 agonists

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14
Q

Where do you find salbutamol?

A

MDI

DPI

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15
Q

Where do you find terbutaline?

A

DPI

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16
Q

What are the adverse side effects of beta 2 stimulants?

A
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17
Q

What are regular preventers?

A

Low dose Inhaled Corticosteroids (ICS) - Preventers

•Beclomethasone

•

•Budesonide

•

•Fluticasone

•

•Ciclesonide

•

•Mometasone

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18
Q

When do you start ICS?

A
  • Using inhaled β2 agonist (“Reliever”) x3/week or more
  • Waking one night a week or more due to asthma
  • Requiring oral steroid for an exacerbation in the past 2 years
  • Symptomatic x3/week or more
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19
Q

What are the advantages of inhaled ICS?

A
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20
Q

What are the side effects of Long term oral cortical steroid use?

A
21
Q

What are the long term side effects of inhaled long term steroids?

A

Dysphonia - difficulty in speaking due to a physical disorder of the mouth, tongue, throat, or vocal cords.

•Oropharyngeal Candidiasis

22
Q

When do you move up the steps from SABA to ICS?

A

If it is being used three times a week

23
Q

What is the next step of asthma management after administration of ICS?

A

Add inhaled low-dose ICS (normally as inhaled combination)

24
Q

What are the ICS long acting beta 2 agonists?

A
25
Q

What should you do if there is no response to LABA?

A

Stop using it and consider an increased dose of ICS

26
Q

What should you do if there is a benefit from LABA but control is still inadequate?

A

Continue LABA and increase ICS to medium dose

Or Continue LABA and ICS and consider LRTA, SR theophylline, LAMA

27
Q

What are the possible high dose therapies?

A

Increasing the ICS up to high dose

Addition of a fourth drug - LRTA, SR theophyline, beta agonist tablet, LAMA

28
Q

Give examples of Leukotrine receptor antagonists

A

Montelukast

•Zafirlukast

29
Q

What is theophylline?

A

Phosphodiesterase inhibitor

Adenosine receptor antagonist

Weak bronchodilator

30
Q

What are the downsides to using Theophylline?

A

Many side effects

Narrow therapeutic window

Unpredictable metabolism - interacts with many drugs

31
Q

Give an example of an inhaled long-acting anti-muscarinic

A

Tiotropium Bromide

32
Q

What is the effect of LAMA?

A

Antagonises muscarinic acetylcholine receptor in bronchial smooth muscle

Some limited evidence of benefit in asthma when added to ICS/LABA

33
Q

What are the side effects of LAMA?

A

Dry mouth

GI upset

Headaches

Can rarely precipitate angle-closure glaucoma- emergency

34
Q

What is the very last stage of asthma treatment?

A

Daily steroid tablets

Maintain high dose ICS

Consider other treatments to minimise the use of steroids

35
Q

Give an example of a long term oral steroid

A

Prednisolone

36
Q

What dose is recommended for long term oral steroids?

A

Lowest oral dose that controls symptoms

37
Q

What is the result of abrupt cessation of oral steroid if on for over 3 weeks?

A

Acute adrenal insufficiency (failure of adrenal glands to produce endogenous glucocorticoid - can be fatal)

38
Q

What is the function of Omalizumab?

A

Monoclonal antibody against IgE

For IgE mediated severe allergic asthma

39
Q

What is the cytokine that is responsible for driving the hypersensitivity in asthma?

A

Interleukin - 5

40
Q

What is the effect of Mepolizumab?

A

Monoclonal antibody against interleukin 5

41
Q

Who is mepolizumab given to?

A

People with poor asthma control (it is an injection)

Long term steroid use or frequent use

Blood eosinophilia

42
Q

What are other steroid sparing drugs?

A
43
Q

What are the non-pharmacological methods of asthma management?

A

Patient education and self-management plans

Inhaler technique

Smoking cessation

Vaccinations (flu/pneumococcal)

Allergen avoidance - removal needed if occupational asthma

Bronchial thermoplasty - heating parts of the airway with a heater probe

44
Q

What is defined as moderate asthma?

A
45
Q

What is defined as acute severe asthma?

A
46
Q

What is defined as life-threatening asthma?

A
47
Q

What is defined as near fatal asthma?

A

Raised PaCO2 and/or requiring mechanical ventilation with raised inflation pressures (504-507)

48
Q

What is the treatment of acute asthma - mild/moderate?

A
49
Q

What is treatment for acute asthma - severe?

A

Ipratropium is a short acting muscarinic drug

  • Consider IV MgSo4 if no response
  • Antibiotics if there is pneumonia / bacterial infection
  • CXR – pneumothorax + asthma = bad. Needs chest drain if unwell.
  • Involve senior medical staff including ITU if life threatening features

–May need anaesthesia, intubation and ventilation in ITU

–In extreme cases ECCO2R may be life saving (Extra cocorial CO2 removal (ECCO2R))

Mustafa respiratory (12 decks)

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