Asthma management in Adults and Children

Question 1

Recap of asthma

Answer 1

• Inflammation of airways, over constriction of bronchial smooth muscle.
• Air is trapped in alveoli
• Wheezing especially in children but not always in adults.
• Breathlessness, chest tightness, difficulty on expiration, coughing
• Decreased peak flow.

Question 2

Signs of asthma

Answer 2

• Wheeze on auscultation
• Obstructed spirometry
• PEF changes
• Respond to treatment- i.e. Treat them for it and they get better – inhaled corticosteroids

Question 3

Management of asthma

Answer 3

• It is very personalised.
• Non pharmacological management is very important in managing asthma:
  o Exercise (as long as you have your asthma controlled and inhaler on you)
  o Smoking cessation and vaping
  o Weight management
  o Flu/pneumococcal vaccinations
• Asthma management plan:
  o Important that the patients know what treatment they are on
• Pharmacological management

Question 4

What does pharmacological management of asthma involve?

Answer 4

• Inhaled therapy
• Oral therapy
• Specialist treatments

Question 5

Inhaled therapy: STAGES.

Answer 5

Suspected?
- Acts as a regular preventer: Low dose of inhaled ICS

Regular preventer:
- Add inhaled LABA to low dose ICS

Additional add-on therapy:
- No response to LABA? Stop LABA and increase dose of ICS
- Some benefit from LABA? Continue with LABA and increase dose of ICS to medium dose
- If LABA is still inadequate, consider other drugs such as:
o LTRA
o ST theophylline
o LAMA
o Beta agonist tablet
- Most serious asthma= introduce daily steroid tablet in the lowest dose possible which provides adequate control while maintain high dose ICD

Question 6

Asthma severity

Answer 6

• Moderate asthma
  o Increasing symptoms
  o PEF > 50-75%

-	Acute severe asthma
o	PEF 33-50%
o	Respiratory rate is > 25/min
o	Heart rate is 110/min
o	Inability to complete sentences in one breath

• Life threatening asthma:
  o PEF < 33%
  o PaO2 < 8kPa (normal is 4.6-6 Kpa)
• Near fatal asthma:
• Raised PaCO2

Question 7

COPD compared to asthma

Answer 7

• COPD very commonly have a smoking history

- Similar therapies with similar non pharmacological management too

Question 8

Asthma management in children

Answer 8

Get the diagnosis right first

Question 9

what is the cure for asthma?

Answer 9

There is no cure for asthma, only palliation or spontaneous resolution.

Question 10

use what technique?

Answer 10

SANE

• Short acting beta agonist/week (two days a week)
• Absent from school or nursery?
• Nocturnal symptoms/week (once a week)
• Exertional symptoms/week

Question 11

If the asthma is not well controlled it might mean:

Answer 11

• Not taking treatment
• Not taking the treatment correctly
• Not asthma
• None of the above- increase the treatment, but to what?

Question 12

Contrast with adults

Answer 12

• Max dse ICS is 800 micrograms
• NO oral B2 tablet
• Start with very low dose ICS or LTRA first line preventer in <5s
• No LAMAS
• Only two biologicals

Question 13

There are three recommendations:

Answer 13

Inhaled corticosteroids:

• Increase ICS dose
• Great, useful for diagnosis, effective, safe
• Adverse effects involve
  o Height suppression
• Inhaler- “go brown”

Add on preventer- Long acting beta agonist (LABA)

• Do NOT use without ICS
• Use as fixed dose inhaler

Add on preventer- Leukotriene receptor antagonist (LTRA)

• Montelukast only
• Rule of thirds
• Better adherence
• Granules are used for reluctant toddlers

Question 14

what is the most correct answer?

Answer 14

The MOST correct answer is add on LABA but keep an open mind

Question 15

Delivery systems

Answer 15

2 types:

• MDI/spacer
• Dry powder device

Spacer:

• Shake Inhaler between puffs
• Wash and use a spacer

Dry powder devise:
Licensed in over 5s but under 8s cant use them

Don’t use nebullisers