Asthma Management Adults Flashcards
What are the 4 main reasons as to why asthma is important
Common
Manageable
Dangerous
Expensive
How many people are currently on treatment for asthma
5.4 million
Is the incidence higher in children or adults
Children
But it is increasing in adults
How many hospital admissions for asthma are avoidable
75%
How many people die every year due to asthma
1200
How many asthma deaths are preventable
90%
How much does it cost the NHS for 60,000 admissions per year
£1 Billion
Is an older or younger patient more likely to die from asthma
Older
What do the airways of the lung consist of
Cartilaginous bronchi
Membranous bronchi
Gas-exchanging bronchi (respiratory bronchioles and alveolar ducts)
What does the cartilaginous bronchi and membranous bronchi mostly function as
Anatomic dead space
Can also contribute to airway resistance
What are the smallest non-gas exchanging airways
Terminal bronchioles
Approximately 0.5 mm in diameter
When are airways considered small
When they are less than 2mm diameter
What is mucosa composed of
Epithelial cells that are capable of specialised mucous production and a transport apparatus
State the 4 cellular elements of asthma
Mast cells
Basophils, esoinphils, neutrophils and macrophages
Stretch and irritant receptors
Cholinergic motor nerves
What are mast cells involved in
The complex control of releasing histamine and other mediators
What are basophils, esoinphils, neutrophils and macrophages responsible for
The extensive mediator release in the early and late stages of bronchial asthma
What do cholinergic motor nerves innervate
Smooth muscle and glandular units
What three things does asthma involve
Airway inflammation
Airflow obstruction
Bronchial hyperresponsiveness
What are the symptoms of asthma
Shortness of breath Wheeze Cough (irritable and dry) Chest tightness Diurnal variability - timing Episodic - reversible Atopy
What are the signs of asthma
Wheeze on auscultation
Eczema/hayfever
Obstructed spirometry
PEF changes
What is an important indication of asthma
Response to treatment
What is the aim of asthma management
Control of the disease
What are the 6 factors that define the complete control of asthma
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 Minimal side effects from medication
What is normal lung function defined as
In practical terms FEV1 and/or PEF>80% predicted or best
Name 5 types of non-pharmacological management methods
Patient education and self-management plans Exercise Smoking cessation Weight management Flu/pneumococcal vaccinations
Why is non-pharmacological management importnat
It can make a bigger difference that medication
What 3 sections are present in the asthma action plan
What they need to do to keep on top of their asthma
The indications that their asthma is getting worse
When they are having an asthma attack
Name the 3 types of pharmacological management methods there are
Inhaled therapy
Oral therapy
Specialist treatments
What do inhalers provide
Small dose of drugs
Where do inhalers deliver the drug
Directly to the target organ
What are the target organs in the asthma
Airways and lungs
What are the benefits of inhalers
Onset of the effect of inhalers is quick
They cause minimal systemic exposure
Systemic adverse effects are less severe and less frequent
What is a pMDI
Metered dose inhaler
What is a pMDI
A device that generate aerosols and requires a low inspiratory flow
What are the disadvantages of pMDI
Requires co-ordination
Elderly and young children cannot use it effectively
What can be attached to pMDI’s to increase efficiency
Spacers
Give three advantages of using spacers
Low oro-pharyngeal deposition of the aerosol
Decrease in the bad taste associated with oral deposition
Reduces risk of oral candidiasis and dysphonia with steroids
How many tidal breaths is sufficient to deliver 2 puffs of salbutamol with a spacer
10
What is DPI
Dry powder inhaler
What generates the aerosol with a DPI
Patient
What does DPI require
High inspiratory flow
Less coordination
What are the 5 steps of asthma treatment
1) Regular preventer (inhaled corticosteriods)
2) Initial add-on therapy (ICS and long acting β-2 agonist)
3) Additional add-on therapies
4) High dose therapies
5) Continuous or frequent use of oral steroids
What are Short acting β2 agonists (SABA)
Relivers
What two types of relievers are there
Salbutamol (MDI, DPI)
Terbutaline (DPI)
Which SABA is used more often
Salbutamol
What are the side effects of salbutamol
Tachycardia
Increase in lactate
Shaking
What do SABAs do
Reduce inflammation
Give examples of inhaled corticosteriods
Beclomethasone Budesonide Fluticasone Ciclesonide Mometasone
When should ICS be used
When the patient feels well as it keeps them well
Give examples of ICS and LABAs
Fostair (pMDI & DPI) - Beclomethasone with formoterol Symbicort (DPI) - Budesonide with formoterol Flutiform (pMDI) - Fluticasone propionate with formoterol Seretide (pMDI & DPI) - Fluticasone propionate with salmeterol Relvar Ellipta (DPI) - Fluticasone fumarate with vilanterol
Which LABA is only used once daily
Relvar
