asthma - principles of management (the 5 therapeutic steps)

Question 1

five therapeutic steps

STEP 1

Answer 1

Mild disease – controlled with short acting bronchodilator alone

Question 2

five therapeutic steps

STEP 2

Answer 2

If need bronchodilator more than once a a day add an inhaled glucocorticoid

Question 3

five therapeutic steps

STEP 3

Answer 3

If asthma uncontrolled longer acting bronchodilator.

Should reduce need for increased doses of glucocorticoid

Question 4

five therapeutic steps

STEP 4

Answer 4

Severe asthma ongoing, maximum dose of glucocorticoid

Add theophylline / montelukast as maybe able to reduce glucocorticoid dose

Question 5

five therapeutic steps

STEP 5

Answer 5

If still poorly controlled added oral glucocorticoid

Question 6

How do you manage Severe acute asthma: status asthmaticus

Answer 6

• Patient hospitalisation
• Oxygen
• Inhalation of nebulised salbutamol
• IV hydrocortisone followed by oral dose of -prednisolone
• Also occasional nebulised ipratropium
• IV salbutamol / aminophylline

Question 7

How do you manage Anaphylaxis (food allergies)?

Answer 7

Adrenaline (IM) (patient may self-administer)
Oxygen
Anti-histamine
Hydrocortisone

Question 8

Define Angio-oedema

Answer 8

intermittent focal swelling of skin that can occur as part of allergic reaction

Question 9

What drugs promote Angio-oedema?

Answer 9

Some drugs can promote condition including aspirin (<10% asthmatics)

Aspirin-sensitive asthmatic patients produce more cysteine leukotrienes causing more airway hyper-responsiveness

Question 10

How do you treat Angio-oedema?

Answer 10

• Treatment with leukotriene antagonists
• steroid therapy
• “aspirin desensitization therapy”