Asthma Managment

Question 1

what are the goals of asthma management?

Answer 1

> minimal symptoms during the day and night
reliever medicine no more than 3 days a week
no exacerbations
no limitation of physical activity

Question 2

Describe the SANE measurement of control?

Answer 2

Short acting beta agonist/week
Absence from school or nursery
Nocturnal symptoms/week
Exertional symptoms/ week

Question 3

describe the assessment of asthma in children?

Answer 3

put on low dose ICS then review in 2 months using the SANE approach

Question 4

describe step one of asthma management in children

Answer 4

put on a regular preventer, low dose inhaled corticosteriods or LTRA if they are under 5.

Question 5

describe step two of asthma management in children

Answer 5

add on preventer either:
> add LABA (probs best)
> add LTRA
> Increase ICS dose

Question 6

why would you start a child on step 2 of asthma management?

Answer 6

> 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

Question 7

what is step three of asthma management in children?

Answer 7

add on therapies: increase ICS or add LTRA

Question 8

what is step 4 in asthma management in children?

Answer 8

> high dose therapies
continuous oral steroids
inhaled corticosteroids
long acting beta agonists as a fixed dose inhaler with ICS
leukotriene receptor agonists, montelukast only

Question 9

what is step five of asthma management in children?

Answer 9

experimental medicine. you would look at compliance and physiological issues.

Question 10

what can you do to increase delivery of medicine to the lungs?

Answer 10

> use a spacer
shake between puffs
wash the spacer monthly to reduce static

Question 11

why might spacers be better than a nebuliser?

Answer 11

> quieter
> cheaper
> wont break down
> portable
> cheaper
> valve mechanism

Question 12

what signs would you use to decide on management of acute asthma?

Answer 12

> respiratory rate
> work of breathing
> heart rate
> ability o complete a sentence
> oxygen saturation
> confusion
> air entry

Question 13

what drugs should you avoid in management of asthma?

Answer 13

> beta-blockers
aspirin
sedatives/strong opiates

Question 14

what are the benefits of inhalers as a drug delivery system?

Answer 14

delivery is to the target organ directly:
>smaller doe needed
> onset is faster
> minimal systematic exposure
> systemic adverse effects are less severe and frequent

Question 15

what do spacers used with metered dose inhalers decrease?

Answer 15

> the speed of the aerosol leading to low pharyngeal deposition
the bad taste
risk of oral candidiasis and dysphonia

Question 16

name some short acting beta 2 agonists

Answer 16

> salbutamol

> terbutaline

Question 17

name some ICS’s used in adults

Answer 17

> beclomethasome
> budesonide
> fluticasone
> ciclesonide
> mometasone

Question 18

when should adults be started on ICS (step 1)?

Answer 18

> 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

Question 19

what is step 2 in asthma management in adults?

Answer 19

ics and long acting beta 2 agonists

Question 20

what is step three in asthma management in adults?

Answer 20

high dose therapies such as:
> leukotriene receptor antagonists
> theophylline
> inhaled long acting anti-muscarinic

Question 21

name some leukotriene receptor antagonists used in adults

Answer 21

> montelukast

> zafilukast

Question 22

what is theophylline?

Answer 22

this is a non-specific phosphodiesterase inhibitor, adenosine receptor agonist and weak bronchodilator

Question 23

what does LAMA act on?

Answer 23

it antagonises M3 muscarinic acetylcholine receptor in smooth muscle.

Question 24

what are some of the side effects of LAMA?

Answer 24

> dry mouth
GI upset
headaches
rarely precipitates angle closure glaucoma

Question 25

what is step 4 in asthma management in adults?

Answer 25

long term oral steroids

Question 26

what problems can arise from long term oral steroids?

Answer 26

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

Question 27

what other treatment can be given at step 4 in asthma management in adults by specialist centres?

Answer 27

> omalixumab a monoclonal antibody against IgE to combat IgE mediated severe allergic asthma
mepolizumab is a monoclonal antibody against interleukin-5

Question 28

give some examples of non-pharmacological treatment of adult asthma

Answer 28

> self-management plans
> smoking cessation
> flu vaccinations
> control of co-morbidities
> removal from inhalation exposure in occupational asthma