Asthma treatment

Question 1

Step 1 for asthma treatment

Answer 1

short-acting beta-2-agonist such as salbutamol

Question 2

step 2 for asthma treatment

Answer 2

SABA + standard dose inhaled steroid (200-800-ug/day judging by disease severity) such as beclometasone

Question 3

step 3 for asthma treatment

Answer 3

long acting beta-2-agonist such as salmeterol + inhaled corticosteroid + SABA

(however if this doesn’t work, up the dose of the inhaled corticosteroids, or try theophylin or a leukotriene receptor antagonist)

Question 4

step 4 for asthma treatment

Answer 4

consider upping the beclometasone up to 2000ug/day + SABA + LABA

oral theophylline, or oral leukotriene receptor (montelukast) may be used in conjunction

Question 5

step 5

Answer 5

SABA + LABA + inhaled corticosteroid + theophylline/leukotriene receptor antagonist (montelukast)

as well as an oral steroid such as prednisolone

then refer to an asthma clinic

Question 6

typical values of FVC, FEV1 and their ratio?

Answer 6

FVC - normal
FEV1 - slightly reduced
ratio (%) - reduced

Question 7

function of Beta-2- adrenorecptor agonists

Answer 7

relax smooth muscle by increasing the amount of cyclic AMP

Question 8

side effects of Beta-2- adrenorecptor agonists

Answer 8

SABA -

tachyarrhythmias
hypokalaemia
tremor
anxiety

LABA -

can cause bronchospasm

Question 9

function of corticosteroids

Answer 9

act over days to reduce bronchial mucosal inflammation - basically anti-inflammatory drugs

Question 10

side effects of corticosteroids

Answer 10

particularly oral candidiasis (oral thrush)

Question 11

methylxanthines function 
(theophylline)

Answer 11

non-specific inhibitor of phosphodiesterase, thus increasing cAMP levels resulting in reduced bronchoconstriction

Question 12

methylxanthine side effects

Answer 12

very narrow therapeutic index - so can cause arrthymias, GI related problems and fits when in the toxic range

Question 13

leukotriene receptor antagonist function

Answer 13

blocks leukotriene receptors by antagonising the CystLT1 receptor

Question 14

Acute management of asthma?

Answer 14

OSHITMAN

O - oxygen - high flow 100% 
S - salbutamol -Nebulised
H - hydrocortisone - given IV
I - ipratropium Bromide IV
T - theophylline 

M - magnesium Sulphate
AN - anaesthetist