Asthma Management - Adults Flashcards
What is the asthma triad?
Airway inflammation
airflow obstruction
Bronchial hyperresponsiveness
What are the signs indicating asthma?
Response to treatment
- episodic
- obstructed spirometry
- eczema
Complete control of asthma is defined as…
- 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 (e.g. steroids)
What is considered normal lung function in terms of FEV1 and PEF?
In practical terms FEV1 and/or PEF>80% predicted or best.
What are the non-pharmacological methods of managing asthma?
- Patient Education and Self management plans
- Exercise
- Smoking cessation
- Weight management
- Flu/Pneumococcal vaccinations
- Asthma reviews/action plans
What are some common inhalers used in relieving asthma?
MDI - metered dose inhalers
DPI - dry powder inhalers
What are some oral therapy drugs that may be used in treating asthma?
- LTRA (e.g. Montelukast)
- Theophylline (bronchodilator)
- Prednisolone (oral steroid)
What are the specialist treatments for asthma?
- omalizumab (anti IgE)
- mepolizumab (anti IL-5)
- bronchial thermoplasty
What are the SABAs used for asthma?
Salbutamol
Terbutaline
What are the features of acute severe asthma?
Any one of:
- PEF 33-50% best or predicted
- respiratory rate >/= 25bpm
- heart rate >/= 110bpm
- inability to complete sentence in one breath
What are the features of life threatening asthma?
- altered conscious level
- exhaustion
- Arrhythmis
- hypotension
- cyanosis
- silent chest
PEF <33% best or predicted
SpO2<92%
PaO2<8kPa
normal PaCO2 (might indicate hypoventilation)
What are the features of a near-fatal asthma attack?
raised PaCO2 and/or mechanical ventilation required
What is the management of a mild/moderate asthma attack out of hospital?
5 points
- Increase inhaler use
- Oral Steroid
- Treat trigger
- Early follow up
- Back up plan
What is the management of a moderate/severe asthma attack in hospital?
8 points
- Nebulisers – Salbutamol/Ipratropium
- Oral/IV Steroid
- IV Magnesium
- Aminophylline
- Triggers – infection/allergen
- Complications – CXR
- Review
- Level 2/3 care
What is the treatment if asthma is suspected?
Monitored treatment of ICS, SABA when required
What is step 1 of asthma treatment?
low dose ICS (e.g. beclometasone)
What is step 2 of asthma treatment?
higher dose ICS + adding in inhaled LABA
What is step 3 of asthma treatment?
Stop LABA (if no response to it) and increase dose of ICS
or
Continue LABA (if beneficial) and increase ICS dose
or
Continue both and add LTRA, theophylline or LAMA.
What is step 4 of asthma treatment?
Trials of:
Increasing ICS up to higher dose
addition of a 4th drug eg. LTRA, slow release theophylline, beta agonist tablet, LAMA
What is step 5 of asthma treatment?
Use daily steroid tablet (e.g. prednisolone) in the lowest dose providing adequate control
or
Maintain high dose ICS
or
Consider other treatments to minimise use of steroid tablets
+ refer to specialist
What are contrasts between asthma and COPD?
Age of onset Smoking history Response to treatment Treatment goals Trajectory
