Asthma - Management of Non-Acute

Question 1

What are the goals of asthma treatment?

Answer 1

• Minimal symptoms during day and night
• Minimal need to reliever medication
• No attacks (exacerbations)
• No limitation on physical activity

Question 2

What is a mneumonic for measuring control?

Answer 2

• SANE
  
  • Short acting beta agonist/week
  • Absence school
  • Nocturnal symptoms/week
  • Exertional symptoms/week

Question 3

What approach is used for medical management of asthma?

Answer 3

Step up and step down approach:

• Started on low dose ICS
• Review after 2 months

Question 4

What are the different classifications of medicine that can be used for asthma?

Answer 4

• Short acting beta agonists
• Inhaled corticosteroids
• Long acting beta agonists
• Leukotriene receptor antagonist
• Theothyllines
• Oral steroids
• Add ons

Question 5

Describe the steps of asthma treatment?

Answer 5

1. When asthma suspected, 2 month trial of very low to low dose ICS
2. Regular preventer – very low (paediatric) dose ICS or LTRA < 5 years
3. Initial add on preventer - very low dose ICS plus inhaled LABA (>5 years) or LTRA (<5 years)
4. Additional add on therapies
   
   1. If no response to LABA stop it and increase ICS to low dose
   2. If response from LABA but control inadequate continue LABA and increase ICS to low dose
   3. If benefit from LABA but control still inadequate continue LABA and ICA and consider trial of other therapy like LTRA
5. High dose therapies – must refer to specialist from here, for severe asthma
   
   1. Trial of ICS up to medium dose
   2. Additional of 4^th drug – theophylline
6. Continuous of frequent use of oral steroids
   
   1. In lowest dose providing adequate control
   2. Maintain medium dose ICS

Question 6

What are differences between paediatric and adult management of asthma?

Answer 6

• Max dose ICS 800mg (<12 years)
• No oral B2 tablets
• LTRA first line preventor in <5s
• No LAMAs
• Only 2 biologics

Question 7

ICS - adverse effects

Answer 7

• Height suppression
• Oral candidiasis
• Adrenocortical suppression

Question 8

What are the different kinds of delivery systems for asthma medication?

Answer 8

• Meter dosed inhaler/spacer
  
  • Always use spacer, get 4x drug reaching lungs
• Dry powder device
  
  • Licensed in over 5s, but most children under 8 cannot use them
• Nebuliser
  
  • Not indicated for day to day use

Question 9

What are non-pharmacological options for treatment of asthma?

Answer 9

• Stop tobacco smoke exposure
• Remove environmental triggers
  
  • Cat, dog