ASTHMA: TREATMENT IN ADULTS Flashcards
Chronic asthma: initial treatment
- Short-acting-beta2-agonist (SABA)
- e.g. Salbutamol (Easyhaler - strongly and deeply)
- or Terbutaline (Bricanyl)
Duration = 4 hours
Onset = 15 mins
When would you go to STEP 1 of asthma treatment?
- Using SABA more than THREE times a week
- Symptomatic more than THREE times a week
- Waking at night due to asthma at least ONCE a week
STEP 1
SABA + **LOW DOSE ICS **
E.g. Beclometasone (Clenil
100mcg TWO puffs BD)
ICS
- Beclometasone (QVAR/CLENIL)
- Fluticasone (Flixotide)
- Ciclesonide (Alvesco)
- Budesonide (Pulmicort)
Equivalent low dose ICS
- Budesonide 100mcg 2 puffs BD (400mcg daily)
- QVAR 50mcg 2 puffs BD
- CLENIL100mcg 2 puffs BD
- Flixotide: 50mcg 2 puffs BD
High dose ICS
High dose Qvar = 100mcg 4 puffs bd = 800mg TDD
STEP 2
SABA + ICS + LTRA/LABA
LTRA = montelukast (15yrs + take 10mg OD)
LABA = salmeterol (serevent) or formoterol (easyhaler) BD. Fixed dose or MART
LABA
- Salmeterol (serevent)
- Formoterol (easyhaler)
DOA = 12 hours
MART = LABA + ICS
- Maintenance
- Reliever
MART examples
1) Fostair (beclometasone diproprionate & formoterol fumarate) (includes pMDI and NEXThaler);
2) DuoResp & Symbicort (budesonide & formoterol)
3) Relvar (Fluticasone furoate & Vilanterol (DPI)
4) Flutiform (fluticasone propionate & formoterol fumarate) pMDI
5) Seretide & AirFluSal (fluticasone propionate & salmeterol), not licenced for < 4
STEP 3
+ LABA if already not added
- Either stop LTRA or continue depending on the response
STEP 4
MART +/- montelukast
STEP 5
High dose ICS
- only as fixed dose, not MART
or
- LAMA or SR theophylline
LAMA
- Ipatropium bromide (20-40mcg TDS/QDS)
- Tiotropium 5mcg OD
LAMA + LABA
- Spiolto (tiotropoium, oldaterol)
- Ultibro (glcyopyrronium + indacterol)
- Duaklir (aclinidium + formeterol)
- Anoro (umeclidinium + vilanterol)
