asthma managment in adults Flashcards
what are the symptoms of asthma?
SOB wheeze cough chest tightness diurnal variability episodic atopy
what are the signs of asthma
wheeze on auscultation eczema obstructed spirometry PEF changes response to asthma treatment
what are the characteristics of complete control of asthma?
- 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
what are the non-pharmacological management techniques for asthma?
- patient education and self management plans
- exercise
- smoking cessation
- weight management
- flu/pneumococcal vaccinations
what are the advantages of inhalers?
drugs are delivered directly to target organs
onset is fast
minimal systemic
exposure
systemic adverse effects are less severe and less frequent
when are pMDIs contraindicated?
when coordination or inspiratory flow is poor
(eg. in the elderly, young children and very unwell)
can cause oral candidiasis and dysphonia
what are the advantages of dry powder inhalers?
require less coordination
what are the SABAs used for asthma?
salbutamol
terbutaline
what are the ICS preventers used in asthma?
beclomethasone budesonide fluticasone ciclesonide mometasone
name some ICS and LABA combinations?
Fostair
Symbicort
Relvar Ellipta
what are the oral therapies for asthma?
leukotriene receptos antagonist
theophylline
prednisolone
what are the specialist treatments for asthma?
omalizumab
mepolizumab
bronchial thermoplasty
what are the features of acute severe asthma?
aby of:
- PEF 33-50% best or predicted
- respiratory rate >/= 25/min
- heart rate >/= 110/min
- inability to complete sentence in one breath
what are the features of life threatening asthma?
-altered conscious level exhaustion -Arrhythmis -hypotension -cyanosis -silent chest
PEF<33% best or predicted
SpO2<92%
PaO2<8kPa
normal PaCO2 (might indicate hypoventilation)
what is the management of a mil/moderate asthma attack out of hospital?
increaes inhaler use oral steroid treat trigger early follow up plan back up plan
what is the management of a mil/moderate asthma attack in hospital?
Nebulisers (Salbutamol/Ipratropium)
Oral/IV Steroid
Magnesium
Aminophylline
triggers-infection/ allergen
complications-CXR
review
what is the treatment if asthma is suspected?
monitored treatment of ICS
what is step 1 of asthma treatment?
low dose ICS
what is step 2 of asthma treatment?
ICS plus inhaled LABA
what is step 3 of asthma treatment?
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
what is step 4 of asthma treatment?
trials of:
increasing ICS up to higher dose
addition of a 4th drug eg. LTRA, slow release theophylline, beta agonist tablet, LAMA
what is step 5 of asthma treatment?
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
when are SABAs used in asthma treatment?
just as required at any stage of treatment
