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Asthma Therapeutics Flashcards

1
Q

What are some of the symptoms experienced in asthma?

A
  • Coughing
  • Wheezing (on expiration)
  • Shortness of breath
  • Chest tightness
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2
Q

True of False: Asthma is diagnosed in patients once they start to experience symptoms.

A

False. Diagnosed after recurrent episodes of symptoms.

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3
Q

State some causes and triggers of asthma.

A
  • Dust
  • Pollen
  • Cold air
  • Medications
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4
Q

Which medications can cause asthma?

A
  • B-blockers
  • NSAIDS
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5
Q

What is the next part in diagnosis when you think a patient has asthma based on their symptoms?

A

Physical examination.

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6
Q

What do you look mainly for in a physical examination?

A

Wheeze (abnormal lung sounds)

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7
Q

What do we look for in a clinical assessment?

A
  • Symptoms
  • Variation in symptom presentation
  • Personal and family history of atopic disease
  • Triggers
  • Signs and symptoms of alternative diagnosis
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8
Q

True or False: A clinical history is sufficient to diagnose a patient with asthma.

A

False. A clinical history along with a supporting objective test.

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9
Q

For patients >16, what is the first line test for asthma, and how would this confirm the diagnosis of asthma?

A
  • Blood eosinophil count - High levels = asthma
  • FeNO (Fractional exhaled Nitric Oxide) - Measure amount of nitric oxide in breath. >=50ppb = asthma
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10
Q

For patients >16, what is the second line test for asthma, and how would this confirm the diagnosis of asthma?

A

Spirometry
- FEV1 of 12% or more AND increase of 200mL = asthma.
- FEV1 10% or more than baseline FEV1 = asthma

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11
Q

For patients >16, what is the third line test for asthma, and how would this confirm the diagnosis of asthma?

A

Peak Expiratory Flow (PEF)
- Variability >20 = asthma

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12
Q

For patients >16, what is the fourth line test for asthma, and what do you test for?

A

Bronchial hyper-responsiveness
- RAST Test for specific IgE antibodies for specific allergens.

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13
Q

For patients 5-16, what is the first line test for asthma, and how would this confirm the diagnosis of asthma?

A

FeNO
- 35ppb or higher = asthma

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14
Q

For patients 5-16, what is the second line test for asthma, and how would this confirm the diagnosis of asthma?

A

Spirometry
- FEV1 of 12% or more = asthma

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15
Q

For patients 5-16, what is the third line test for asthma, and how would this confirm the diagnosis of asthma?

A

Peak Expiratory Flow
- Variability of 20% or more = asthma

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16
Q

For patients 5-16, what is the fourth line test for asthma?

A
  • Skin Prick test
  • Blood tests to measure IgE/eosinophils
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17
Q

How would you diagnose a child who is under the age of 5?

A

Treat based on clinical judgement and review regularly.

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18
Q

What is the normal eosinophil range?

A

0-300cells/microL

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19
Q

What is one downside of Spirometry?

A

It is only performed at a single point in time so a negative result would not rule out asthma.

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20
Q

Why might Spirometry not be preferred in children?

A

They may not be able to perform it as it requires high levels of expiratory force.

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21
Q

How is Spirometry performed?

A
  1. Patient will breathe into a spirometer to get three readings. Best of three is recorded.
  2. Take 2 puffs of a rapid acting bronchodilator (Salbutamol)
  3. Repeat step 1
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22
Q

What are the three readings obtained in Spirometry?

A

FVC (Forced Vital Capacity) - Total volume of air the patient can exhale in one breath
FEV1 (Forced expiratory volume in one second) - Total volume of air exhaled in one second
FEV1/FVC

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23
Q

What value for FEV1/FVC would confirm obstructive airways disease?

A

<0.7
The use of 2 puffs of a bronchodilator after which shows reversibility would confirm asthma.

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24
Q

How is peak flow performed?

A
  • Three readings taken morning and evening with the best recorded.
  • Calculate over 2 weeks to obtain 28 readings.
  • Difference between best and worst calculated as % of average
  • 20% = asthma
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25
What are the two type of beta agonists for treatment of asthma?
- Short Acting Beta Agonists (SABA) - Long Acting Beta Agonists (LABA)
26
What are SABAs used for? Give an example.
For the relief of symptoms -> Salbutamol, terbutaline
27
Give some examples of LABAs.
Formoterol, salmeterol
28
Which LABA is preferred?
Formoterol as it has a rapid onset and a long duration of action which makes it good as a reliever and preventer. Other LABAs have a long duration of action but also a slower onset, making them only suitable as preventers.
29
Why is salbutamol preferred over terbutaline?
Easier to use.
30
What are some side effects of SABA use and why might this be?
Fine tremors of the hands and hypokalaemia -> tachycardia. This could be due to the overuse of the SABA.
31
What must be taken alongside a LABA and why?
An ICS. LABA is used to open up the airways, however, ICS is used to reduce inflammation.
32
What are the three treatments used for prevention in asthma?
- ICS - Leukotriene receptor antagonists - Long-acting muscarinic receptor antagonists
33
True or False: All asthma patients should be given ICS.
True
34
Give some examples of ICS.
Beclomethasone diproprionate, budesonide, fluticasone fumarate
35
Which two ICS are only licensed to use with formoterol?
- Beclomethasone diproprionate - Budesonide
36
Give an example of a leukotriene receptor antagonists.
Montelukast
37
Give an example of long-acting muscarinic receptor antagonists.
Tiotropium
38
What treatment is first line for children under the age of 12?
ICS with a SABA
39
What are the 2 branded Beclomethasone mono therapy treatments?
- QVAR - Clenil -> have to be brand prescribed as different doses
40
What is a side effect of the use of ICS and how can it be managed?
Oral thrush - rinse mouth out after use - use a spacer device
41
When is montelukast usually taken?
Taken at night.
42
What is a side effect of montelukast?
Neuropsychiatric reaction - anxiety, aggression
43
Tiotropium is usually taken when?
In the morning.
44
Tiotropium is often given as what?
A respimat device
45
What is the main side effect of taking tiotropium?
Dry mouth
46
Why is theophylline a high risk medication?
It has a narrow therapeutic index Metabolised by the CYP450 enxyme -> enzyme induction and enzyme inhibition -> fluctuating concentrations
47
How often should plasma levels be checked when on theophylline?
- 5 days after start of treatment - 3 days after every dose change
48
What are the overdose signs of theophylline?
- Hypokalaemia - Tachycardia - Hyperglycaemia - Dilated pupils - Restlessness - Agitation
49
When are preventer therapies usually taken?
In the morning and evening.
50
Clenil modulite is a brand therapy for which drug?
Beclomethasone diproprionate
51
What drugs are found in DuoResp?
Budesonide and formoterol.
52
What is the new guidelines for the treatment of asthma in adults and children >12 yrs?
ICS-Formoterol for prevention and relief
53
Why are the new guidelines preferred over the old guidelines?
Proven to reduce exacerbations, and therefore, reduce hospitalisations and mortality.
54
Give some examples of poor control of asthma.
- Asthma attack in the past 2 years - Use of reliever inhaler >=3 times per week - Symptomatic >=3 times per week - Waking 1 night per week - Affects daily activities
55
For the new guidelines, what is the initial branded therapies available for adults and children aged 12 and over?
AIR - Anti-inflammatory reliever - DuoResp Spiomax 160/4.5mcg - Symbicort Turbohaler 100/6mcg or 200/6mcg -> To take ONE puff when required (max. 8)
56
The AIR therapy of a low dose ICS-formoterol contains which two drugs?
Budesonide and formoterol.
57
When may a patient be put on the second step of treatment which is the low-dose MART regime?
- When they are immediately diagnosed and are highly symptomatic - Asthma is not controlled on low dose ICS-Formoterol
58
What are three examples of branded inhalers for a low-dose MART regime?
- DuoResp Spiromax 160/4.5 mcg - Symbicort Turbohaler 100/6 mcg - Symbicort Turbohaler 200/6 mcg
59
For a low-dose MART regime, what is the dosing requirements when taking the medication?
1 puff in the morning and night for prevention, and 1 puff when required for relief. -> max. 8 puffs in 24hrs
60
What three branded inhalers are used in the moderate-dose MART regime?
- DuoResp 160/4.5 mcg - Symbicort Turbohaler 200/6 mcg - Fostair 100/6 mcg evohaler/NEXThaler
61
For a moderate-dose MART regime, what is the dosing requirements when taking DuoResp and Symbicort?
Take 2 puffs in the morning and evening for prevention, and 1 puff when required for relief. -> max. 8 puffs in 24 hrs
62
Which 2 drugs does a Fostair 100/6 mcg evohaler/NEXThaler include and what are the dosing requirements?
Beclomethasone and formoterol. Take 1 puff in the morning and evening for prevention, and 1 puff when required for relief. -> max. 8 puffs in 24 hrs
63
Why is formoterol the only LABA that can be used in the MART regime?
Only LABA with a rapid onset.
64
What happens if a patient is on a moderate-dose MART regime and still remain poorly controlled?
Check FeNO and blood eosinophils - Raised -> specialist - Low -> add on therapies (montelukast or tiotropium)
65
For patients aged 5-11, which treatment is given initially?
Low-dose ICS for prevention and Salbutamol for relief - Clenil modulite (beclomethasone) - Salbutamol

PHA223 (11 decks)

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