Asthma Treatment

Question 1

What is the first line of asthma treatment?

Answer 1

Low dose of ICS

LTRA if under 5. Think T for toddler

Question 2

What is second line of treatment

Answer 2

ICS + LABA
ICS + LTRA if under 5

Question 3

Third line treatment in kids

Answer 3

Increase in ICS + increase in LABA + LTRA if beneficial

Question 4

What are considerations for children

Answer 4

No oral B2 tablet
No LAMAs
ICS < 800mg in u12s
Don’t use nebulisers
Don’t use dry powders in u8s

Can use B2 agonists with v low dose 2 days a week if symptomatic 3 x a week or 1 night/week

Question 5

What should be used to deliver inhaler medicine

Answer 5

MDI/Spacer -> 4 x bench with spacer
2 x better when shaken vs not shaken

Question 6

What is the second line treatment in adults

Answer 6

ICS + LABA

Question 7

What is the third line treatment in adults?

Answer 7

Increase ICS + LABA (if seen as beneficial)

Can add LTRA if ICS and LABA beneficial but not doing enough

Can also consider SR theophylline and LAMA

Question 8

Final stage?

Answer 8

Addition of fourth drug like LTRA, SR theophylline and Bagonist tablet. If that still isn’t good enough then…

High dose of ICS, Steroid tablets and refer to specialist

Question 9

What are you SABA options?

Answer 9

Salbutamol
Terbutaline

Question 10

What are your oral therapy options?

Answer 10

LTRA, Theophylline, Prednisolone, Specialist treatment

Question 11

What would an acute mild/moderate attack require?

Answer 11

Inhaler increase use
Oral steroid
Treat trigger

Question 12

What would a moderate/sever acute attack require?

Answer 12

Hospitalised
Nebulisers
Oral/Iv steroid
Magnesium
Aminophylline
Infection/allergen trigger
CXR if complication

Question 13

What investigations do you do to diagnose asthma in adults?

Answer 13

Spirometry - FEV1/FVC < .7 or FEV1 < .8
Full pulmonary function and reversibility to B2 agonist
If spirometry normal then peak flow monitor 2/day for 2 weeks. Then bronchial provocation or nitric oxide

You also want to check their reversibility to bronchodilators

FEV1 > 200ml & FEV1 > 12% from baseline

Oral corticosteroids can separate COPD from Asthma

0.6 mg/kg prednisolone in 14 days
Peak flow chart meter
2 week spirometry

Question 14

What are diagnosis signs and symptoms for asthma patients?

Answer 14

Recurrent episodes of reversibility
Symptom variability
Observation of wheeze
Hx of atopy - skin prick test for IgE and FBC (eosinophilia)
Symptoms don’t = alternate diagnosis
Hx of variable PEF or FEV1

Question 15

What should we look for in variability?

Answer 15

Morning/nocturnal dips
Decline over weeks/days
Variability > 20% on > 3 days/week

Question 16

What we use CXR for if anything?

Answer 16

Check no collapse, effusion, hyperinflatio