Asthma Managment Flashcards
what are the goals of asthma management?
> minimal symptoms during the day and night
reliever medicine no more than 3 days a week
no exacerbations
no limitation of physical activity
Describe the SANE measurement of control?
Short acting beta agonist/week
Absence from school or nursery
Nocturnal symptoms/week
Exertional symptoms/ week
describe the assessment of asthma in children?
put on low dose ICS then review in 2 months using the SANE approach
describe step one of asthma management in children
put on a regular preventer, low dose inhaled corticosteriods or LTRA if they are under 5.
describe step two of asthma management in children
add on preventer either:
> add LABA (probs best)
> add LTRA
> Increase ICS dose
why would you start a child on step 2 of asthma management?
> if they are using their beta agonist more than 3 times a week
if they are symptomatic more than 3 times a week
if they are waking at night or if they have had an exacerbation of asthma in the last 2 years
what is step three of asthma management in children?
add on therapies: increase ICS or add LTRA
what is step 4 in asthma management in children?
> high dose therapies
continuous oral steroids
inhaled corticosteroids
long acting beta agonists as a fixed dose inhaler with ICS
leukotriene receptor agonists, montelukast only
what is step five of asthma management in children?
experimental medicine. you would look at compliance and physiological issues.
what can you do to increase delivery of medicine to the lungs?
> use a spacer
shake between puffs
wash the spacer monthly to reduce static
why might spacers be better than a nebuliser?
> quieter > cheaper > wont break down > portable > cheaper > valve mechanism
what signs would you use to decide on management of acute asthma?
> respiratory rate > work of breathing > heart rate > ability o complete a sentence > oxygen saturation > confusion > air entry
what drugs should you avoid in management of asthma?
> beta-blockers
aspirin
sedatives/strong opiates
what are the benefits of inhalers as a drug delivery system?
delivery is to the target organ directly:
>smaller doe needed
> onset is faster
> minimal systematic exposure
> systemic adverse effects are less severe and frequent
what do spacers used with metered dose inhalers decrease?
> the speed of the aerosol leading to low pharyngeal deposition
the bad taste
risk of oral candidiasis and dysphonia
name some short acting beta 2 agonists
> salbutamol
> terbutaline
name some ICS’s used in adults
> beclomethasome > budesonide > fluticasone > ciclesonide > mometasone
when should adults be started on ICS (step 1)?
> if they are using their beta 2 agonist 3 times a week
waking 1 night or more a week due to asthma
requiring oral steroids for an exacerbation in the last 2 years
symptomatic 3 times a week or more
what is step 2 in asthma management in adults?
ics and long acting beta 2 agonists
what is step three in asthma management in adults?
high dose therapies such as:
> leukotriene receptor antagonists
> theophylline
> inhaled long acting anti-muscarinic
name some leukotriene receptor antagonists used in adults
> montelukast
> zafilukast
what is theophylline?
this is a non-specific phosphodiesterase inhibitor, adenosine receptor agonist and weak bronchodilator
what does LAMA act on?
it antagonises M3 muscarinic acetylcholine receptor in smooth muscle.
what are some of the side effects of LAMA?
> dry mouth
GI upset
headaches
rarely precipitates angle closure glaucoma
what is step 4 in asthma management in adults?
long term oral steroids
what problems can arise from long term oral steroids?
there are many side effects and it can result in acute adrenaline insufficiency where the adrenal glands fail to produce endogenous glucocortoid which can be fatal
what other treatment can be given at step 4 in asthma management in adults by specialist centres?
> omalixumab a monoclonal antibody against IgE to combat IgE mediated severe allergic asthma
mepolizumab is a monoclonal antibody against interleukin-5
give some examples of non-pharmacological treatment of adult asthma
> self-management plans > smoking cessation > flu vaccinations > control of co-morbidities > removal from inhalation exposure in occupational asthma
