asthma managment in adults

Question 1

what are the symptoms of asthma?

Answer 1

SOB
wheeze
cough
chest tightness
diurnal variability
episodic
atopy

Question 2

what are the signs of asthma

Answer 2

wheeze on auscultation
eczema
obstructed spirometry
PEF changes
response to asthma treatment

Question 3

what are the characteristics of complete control of asthma?

Answer 3

• no daytime symptoms
• no night-time awakening due to asthma
• no need for rescue medication
• no asthma attacks
• no limtations on activity including excercise and normal lung function (very hard to achieve)
• minimal side effects from medication

Question 4

what are the non-pharmacological management techniques for asthma?

Answer 4

• patient education and self management plans
• exercise
• smoking cessation
• weight management
• flu/pneumococcal vaccinations

Question 5

what are the advantages of inhalers?

Answer 5

drugs are delivered directly to target organs
onset is fast
minimal systemic
exposure
systemic adverse effects are less severe and less frequent

Question 6

when are pMDIs contraindicated?

Answer 6

when coordination or inspiratory flow is poor
(eg. in the elderly, young children and very unwell)
can cause oral candidiasis and dysphonia

Question 7

what are the advantages of dry powder inhalers?

Answer 7

require less coordination

Question 8

what are the SABAs used for asthma?

Answer 8

salbutamol

terbutaline

Question 9

what are the ICS preventers used in asthma?

Answer 9

beclomethasone
budesonide
fluticasone
ciclesonide
mometasone

Question 10

name some ICS and LABA combinations?

Answer 10

Fostair
Symbicort
Relvar Ellipta

Question 11

what are the oral therapies for asthma?

Answer 11

leukotriene receptos antagonist
theophylline
prednisolone

Question 12

what are the specialist treatments for asthma?

Answer 12

omalizumab
mepolizumab
bronchial thermoplasty

Question 13

what are the features of acute severe asthma?

Answer 13

aby of:

• PEF 33-50% best or predicted
• respiratory rate >/= 25/min
• heart rate >/= 110/min
• inability to complete sentence in one breath

Question 14

what are the features of life threatening asthma?

Answer 14

-altered conscious level
exhaustion
-Arrhythmis
-hypotension
-cyanosis
-silent chest

PEF<33% best or predicted
SpO2<92%
PaO2<8kPa
normal PaCO2 (might indicate hypoventilation)

Question 15

what is the management of a mil/moderate asthma attack out of hospital?

Answer 15

increaes inhaler use
oral steroid
treat trigger
early follow up
plan back up plan

Question 16

what is the management of a mil/moderate asthma attack in hospital?

Answer 16

Nebulisers (Salbutamol/Ipratropium)
Oral/IV Steroid
Magnesium
Aminophylline

triggers-infection/ allergen
complications-CXR
review

Question 17

what is the treatment if asthma is suspected?

Answer 17

monitored treatment of ICS

Question 18

what is step 1 of asthma treatment?

Answer 18

low dose ICS

Question 19

what is step 2 of asthma treatment?

Answer 19

ICS plus inhaled LABA

Question 20

what is step 3 of asthma treatment?

Answer 20

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

Question 21

what is step 4 of asthma treatment?

Answer 21

trials of:
increasing ICS up to higher dose
addition of a 4th drug eg. LTRA, slow release theophylline, beta agonist tablet, LAMA

Question 22

what is step 5 of asthma treatment?

Answer 22

use daily steroid tablet in the lowest dose providing adequate control
or
maintain high dose ICS
or
consider other treatments to minimise use of steroid tablets

Question 23

when are SABAs used in asthma treatment?

Answer 23

just as required at any stage of treatment