Asthma- pharmacologic treatment

Question 1

Poor inhaler technique is seen in _% of patients and is assocaited with _ and _

Answer 1

70%
poor control, increased exacerbations

Question 2

What should be recommended in patients prescribed a pressurized meter dose inhaler (pMDi)?

Answer 2

valved holding chamber

esp for inhaled corticosteroids

Question 3

Who may struggle with dry powder inhalers?

Answer 3

adults with low FEV1 and during exacerbations

Question 4

What medication should all people with asthma have access to?

Answer 4

reliever medication

Question 5

What is the purpose of a reliever medication

Answer 5

PRN use to treat acute symptoms

Question 6

What 2 classes of inhalers are approved for reliever use

Answer 6

SABAs + combo bud/form

Question 7

What are SABAs

Answer 7

Short acting beta agonists
stimulate beta 2 receptors on smooth muscle cells of airway causing relaxation (bronchodilation)

Provide rapid relief
never used as control meds

Recall- agonists activate receptors
antagonists block receptors

Question 8

What are the 2 common SABAs

Answer 8

salbutamol (ventolin)
terbutaline (Bricanyl Turbuhaler)

Question 9

What are the common side effects of SABAs

4

Answer 9

tremor, tachy, anxious, pharyngitis

Question 10

What are common metablic disturbances of SABAs

3

Answer 10

decrease K
decrease phosphate
increase glucose

rarely clinically significant

Question 11

Caution use of SABAs in which patients

3

Answer 11

CVD (arrhythmias, HTN)
hypothyroid
seizures

Question 12

Budesonide/formoterol (Symbicort)
What is it used for?

Answer 12

can be used as reliever but also maintenance therapy

is not a SABA- is a combo inhaler

Question 13

What is Budesonide/formoterol (Symbicort) a combination of?

Answer 13

Inhaled corticosteroid (ICS) and Long-acting beta-2 agonist (LABA)

ICS/LABA

agonist- activate receptors to cause relaxation
steroid- decease inflammation

Question 14

Common side effects of Bud/form

3

Answer 14

oral thrush, headache, congestion

use cautiously in CVD

Question 15

When should Bud/Form not be used as a reliever?

Answer 15

When controller meds other than maitenance bud/form are being used

Question 16

For controller therapy what should be kept in mind when prescribing

Answer 16

safest, smallest effective ICS dose that acheives control and eliminates exacerbations

Question 17

How long does it take to see improvement with controller therapy

Answer 17

1-2 weeks after starting daily ICS

plateau in 1 month

Question 18

FYI examples of controller therapy:

• Beclomethasone dipropionate HFA (QVAR)
• Budesonide* (Pulmicort)
• Ciclesonide* (Alvesco)
• Fluticasone furoate* (Arnuity)
• Fluticasone propionate (Flovent)
• Mometasone furoate* (Asmanex)

Answer 18

fyi

Question 19

Are all patients on controller therapy

Answer 19

no

Question 20

For well controlled patients who are on no meds or PRN SABA with low exacerbation risk what are the three options for continuation of treatment

not increase, just options for continuing

3

Answer 20

• start/continue on PRN SABA
  OR change to below options for better control or reduction of risk for exacerbations:
• daily ICS+ PRN SABA
• PRN bud/form

Question 21

For well controlled patients who are on no meds or PRN SABA with higher exacerbation risk what is the issue

Answer 21

should NOT just be on PRN SABA if at higher risk of exacerbation, even with minimal symptoms

Question 22

For well controlled patients who are on no meds or PRN SABA with higher exacerbation risk what should they be switched to

Answer 22

daily ICS+PRN SABA

daily ICS+ PRN SABA preferred over PRN bud/form unless pt not compliant with 2 meds

Question 23

For patients not well controlled on PRN SABA or no meds what is the next step?

Answer 23

daily ICS+PRN SABA

SABAs seem to be preferred over bud/form

Question 24

What do leukotriene receptor antagonists (LTRAs) do

Answer 24

block (antagonist) action of leukotrienes which are inflammatory chemicals - prevent bronchoconstriction, mucus production, inflammation

example montelukast (singulair)

Question 25

Where do leukotriene receptor antagonists (LTRAs) fit in with ICS

Answer 25

second line to daily ICS