Asthma NEW PRSC Flashcards
Extra info
Learn generic inhaler names. Brands will be given
Chronic asthma- Inflammatory condition of airways varies in frequency and severity but is always there
Acute asthma - asthma exacerbation or flare up - happens suddenly
Exam predictions
Revise these 1st
- Inhalers and their devices (how to use, clean etc)
- Picking best inhaler based on scenarios
- Optimise treatment when to step up/down
- COPD GOLD guidance
- Mainly EMQs
- Difference between asthma and COPD
General Signs/Symptoms
Cough, Wheeze, Chest tightness, and Breathlessness.
Vary over time and intensity can change.
- More severe for acute below
Acute Asthma - Refer to pics table
Happens suddenly
- Can be life threatening (symptoms below)
Reading tell the severity (HR, PEF, RR [12-16 normal], SpO2 [>95% = healthy])
Diagnosis of severity
1. MODERATE - Home treatment
PEF 50-75%, Normal speech,
- High dose SABA (up to 10 puffs) can use spacer
2. Severe - Hospital treatment
PEF 33-50%, RR >25/min, HR>110/min, speech issues
- Nebuliser - Life threatening, ALT IV or if inhaling is issue
3. Life threatening - Hospital treatment
PEF <33%, SpO2 <92% & Symptoms (cyanosis, exhaustion, Hypotension)
- Treatment same as severe
Signs/Symptoms
Rapid breathing
Higher HR
Laboured breathing
Cyanosis
Reduced O2 Sats
Acute Asthma Treatment
AS above in diagnosis +
ALL should be started on oral prednisolone
ALT IV hydrocortisone/IM methylprednisolone
- Doses prednisolone - >12 MAX 40-50 mg OD. <12 MAX 40 mg. Dose is BW dependent 1-2mg/kg
NOTE- Steroid inhalers not the best for acute asthma dont provide instant relief
NEBULISER 1st choice salbutamol >5 yrs- 5mg, <5yrs 2.5mg
ALT Ipratropium 500mcg every 4/6 hrs
Chronic Asthma - PICs for treatments
Chronic is inflammatory condition of airways - can vary in frequency/severity (can be seasonal)
Treatment is split in ages 12≥, 5-11 or ≤5
Signs/Symptoms
SOB, Wheezing, Cough (worse at night), Chest tightness
Controlled asthma = No symptoms, no attacks, no rescue meds, no waking at night, normal lung function.
- Reasons for poor control - technique, wrong meds, adherence, smoker, environment, meds overuse.
Trigger factors
Physical activity, Infections, stress, emotions, meds (NSAIDs, B-Blocker), Allergens, weather (cold), environment, foods/activities
Chronic Asthma Treatment - PICs
Non-Pharmacological
Weight loss, Smoking cessation, breathing programme help/exercise
Pharmacological
Uncontrolled asthma (1/+) = Symptoms >3 times/week, Waking at night, Asthma control test score (bad [pics])
- Above would mean need to STEP UP treatment
Controlled asthma - can STEP DOWN treatment:
- Controlled for at least 3 months, Decrease maintenance and AIM for lowest dose ICS
- ICS only stopped completely if on low dose ICS + NO symptoms
Allow 8-12 weeks between each step down and use triggers to judge when step down (i.e. cold weather)
KEY INFO
- AIR (anti-inflammatory reliver) = ICS + LABA (Formoterol) - used when needed SOB and quick relief (1 INHALER) reduces steroid use overall as provides small amounts when required rather than prednisolone.
Budesonide + Formoterol (Symbicort) licenced. DONT NEED SABA with this. Always is formoterol
- MART - regular daily (1 INHALER) DONT NEED SABA. They are used regular and WHEN NEEDED.
High dose = 2 puff BD
Low dose = 1 puff BD - regardless of 100/6 or 200/6
- MART = FOSTAIR, Symbicort, DuoResp Spiromax, Fobumix
MAX for both are 8 puffs a day
>12 yrs old treatment PIC
AIR therapy (step 1) can be skipped if highly symptomatic/Hospitalised. IF KNOWN exercise induced asthma LTRA trialled b4 LAMA
5-11 yrs old treatment PIC
Step 1 BD paediatric low dose ICS. STEP 2 DEPENDS on if MART able. IF unable its SABA +LTRA etc
MART unable PTs can be carried on with LTRA through next steps if good response
- ALL FAIL = REFER
<5 yrs old treatment PIC
Step 1 low dose ICS + SABA. STEP 2 DEPENDS ON RESPONSE TO STEP 1.
- Step 1 FAIL = REFER
- Good response = try stopping after 2/3 months, Review 3 months later, RESTART if needed (can try moderate dose - if fail then LTRA trial [2/3 months])
NOTE: PT on old guidelines you can change them to consider MART if controlled
Follow up on Chronic asthma
Review changes in 4-8 weeks or sooner.
Aim for lowest dose of ICS - reduce AEs
Exercise induced asthma (type of chronic)
Symptoms happen from exercise. Doesn’t specifically mean exercise can be normal activities (shopping).
SABA is used before exercise
LAMA/LTRA are better to fight this long term as they reduce inflammation better.
Asthma Pregnancy
Prevents risk like lack of O2 to mother/baby.
Stop smoking is A MUST.
Inhalers are all the same and oral prednisolone can be used when acute attack occurs.
Extra info to understand Asthma treatment
Eosinophils are type of WBC - that release inflammatory mediators
- High = >airway inflammation, swelling, mucous production = they causes asthma symptoms
- >300 cells = high
FeNO - LEARN RANGES (pics)
Conc. of nitric oxide in breath
- its a marker of inflammation - helps find the type of asthma
- FeNO - >50ppb = eosinophilic asthma (steroids helpful)
- FeNO + high Eosinophil count help show steroid responsive asthma (steroids reduce inflammation)
– these counts also help see if PT is using steroid inhaler.
