Asthma VI: Wrap-up

Question 1

Exercise-Induced Bronchospasm (EIB)

Management

Answer 1

• Short-acting β2- agonists are the first-line treatment
• Only if required, they are used 15 minutes before exercise, peak action of 15 to 60 minutes, last 3 hrs
• Tachyphylaxsis with daily use - reserve for strenuous
• Addition of controller if SABA is used daily or more

• LTRA benefiticl
• Montelukast prevent for up to 24 hrs after single dose
- SABA more effective than montelukast

Question 2

Exercise-Induced Bronchospasm (EIB)

Non-pharm prevention

Answer 2

warm up
cool down
heat exchange mask: not as effective as pre-treatment with salbutamol
nutrition: salt restriction, high omega 3 (low evidence)

Question 3

Work-Related Asthma (WRA)

Management

Answer 3

• same as other asthma

- primary prevention through the control of exposures

Question 4

Perimenstrual Asthma (PMA)

Management

Answer 4

-In patients who see deterioration around the menstrual cycle, pre-emptive changes in therapy can
help to reduce exacerbation risk and to reduce the impact of the condition on the patient
- increase anti inflamm therapy prior to mens

Question 5

Asthma in Pregnancy

Management

primary goal?
what is preferred drug?

Answer 5

• The advantages of actively treating asthma in pregnancy markedly outweigh any potential risks of usual controller and reliever medications.
• steroid tablets are not teratogenic
slight concern that they may be associated with oral clefts

• Ultimate goal to maintain enough oxygen for fetus
• ICS first line controller
• budesonide preferred
• Continue to suggest reliever (SABA) prn and monitor

Question 6

Diagnosis of Asthma in Preschool Children

Most children have an onset of asthma in preschool years (ages 1-5 years)

Terms such as ‘bronchospasm,’ reactive airway disease,’ ‘wheezy bronchitis,’ and ‘happy wheezer’ should be abandoned.

Answer 6

• can’t perform spirometry or these physical tests

early diagnosis

• Early wheezing may be associated with a reduction in FEV1 that persists into adulthood
• Avoiding treatment delay

documentation of signs or symptoms of airflow
obstruction, reversibility of obstruction, and no clinical suspicion of an alternative diagnosis

• >2 recurrent episodes of asthma-like symptoms and wheezing on presentation
• direct observation of improvement with inhaled bronchodilator by a trained
provider

Question 7

Management of Asthma in Preschool Children

For mild / intermittent symptoms
persistant/mod-severe?

Answer 7

For mild / intermittent symptoms
 PRN SABA may be sufficient

For persistent symptoms or with moderate-severe exacerbations
 1st line = inhaled ICS at lowest effective dose with prn SABA
• If a patient has been trialed and controlled on a medium-dose ICS, the dose should be decreased by 50% every 2-3 months until the lowest effective dose is achieved.
• If control still not achieved with a medium-dose ICS, the child should be referred.

Other
• Daily LTRA should be 2nd line only (ICS are more effective)
• Stepping up ICS therapy in times of sickness (URTIs) is not tested in this age-group
• Intermittent use of therapies at symptom onset does not show benefit

Question 8

COVID-19 and asthma

Answer 8

continue taking their prescribed asthma medications, ICS, OCS
- Stopping ICS often leads to potentially dangerous
worsening of asthma
 For patients with severe asthma: continue biologic therapy, and do not suddenly stop OCS

Avoid nebulizers where possible
 Nebulizers increase the risk of disseminating virus
MDI preferred

Avoid spirometry in patients with confirmed/suspected COVID-19 - disseminate viral particles

Question 9

practice case on slides

Answer 9

ok

Question 10

DOSING FOR THESE DRUGS

Salbutamol
Symbicort
Oral prednisone for an exacerbation
Inhaled corticosteroids as provided in the table
Serevent
Advair
Atrovent

Answer 10

Salbutamol
Symbicort
Oral prednisone for an exacerbation
Inhaled corticosteroids as provided in the table
Serevent
Advair
Atrovent