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BNF > CHAPTER 3: Respiratory: Asthma > Flashcards

CHAPTER 3: Respiratory: Asthma Flashcards

1
Q

Which groups of people can find pMDI difficult to use? (2)

A
  1. Elderly

2. Children

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2
Q

What device can children and the elderly be given to help them use pMDIs?

A

Spacer device

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3
Q

If they cannot use a pMDI, who can benefit from a dry powder inhaler?

A

Adults and children over 5

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4
Q

Provided the can use the device effectively, who are breath actuated devices suitable for?

A

Adults and older children

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5
Q

What may occur as a side effect of using a dry powder inhaler?

A

Coughing

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6
Q

What do spacer devices remove the need for?

A

Coordination between actuation and inhalation of pMDI

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7
Q

What does a space device reduce?

A
  1. Velocity of particle

2. Impaction on the back of the throat

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8
Q

What does a spacer device allow more time for?

A

Inhalation

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9
Q

Who are spacer devices particularly useful for? (4)

A
  1. Poor inhalation technique
  2. Children
  3. High dose ICS
  4. Oral thrush with ICS
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10
Q

Which is the most effective spacer device?

A

A one way valve volumatic

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11
Q

Are spacer devices interchangeable?

A

No, patients should be advised not to switch between them

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12
Q

When using spacer devices, what type of breathing is as effective than single breaths?

A

Tidal breathing

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13
Q

How often should a spacer device be cleaned?

A

Once a month

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14
Q

When cleaning a spacer device, what must a patient NOT do? (2)

A
  1. Rinse it

2. Dry it

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15
Q

How often should spacers be replaced?

A

Every 6-12 months

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16
Q

In which condition are nebulisers used?

A

Severe acute asthma

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17
Q

How long are nebulisers administered for?

A

5-10 minutes

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18
Q

What are nebulisers driven by?

A

Oxygen

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19
Q

Why is it preferable for patients to have oxygen during a severe acute asthma attack instead of a beta2 agonist?

A

Beta2 agonist can increase arterial hypoxaemia

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20
Q

What are the main indications for use of a nebuliser? (6)

A
  1. Beta2 agonist - acute exacerbation of asthma
  2. Ipatropium - acute exacerbation of COPD
  3. Beta2 agonist, ICS, Ipatropium - regular administration for severe asthma/reversible obstruction
  4. Antibiotic - CF
  5. Budesonide/adrenaline - severe croup
  6. Pentamidine - prophylaxis and treatment PCP
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21
Q

The use of nebulisers in persistent asthma and COPD should be considered in which situations? (4) - Patient should have a 2 week trial

A
  1. Review of diagnosis
  2. Review of therapy and inhaler technique
  3. Increased doses from hand-held devices have been tried for 2 weeks
  4. Patient remains breathless after trying multiple things
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22
Q

What is the proportion of the drug to reach the lungs after administration via nebuliser?

A

10%

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23
Q

Give 4 examples of drugs that can be given by mouth

A
  1. Beta2 agonists
  2. Corticosteroids
  3. Leukotriene receptor antagonists
  4. Theophylline
  5. Aminophylline
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24
Q

Give 3 examples of drugs that can be given IV

A
  1. Beta2 agonists
  2. Corticosteroids
  3. Aminophylline
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25
Q

Asthma is characterised by broncoconstriction, what are the most frequent symptoms? (4)

A
  1. Chest tightness
  2. Shortness of breath
  3. Wheezing
  4. Coughing
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26
Q

Broncoconstriction in asthma is usually reversible, however it may get worse and which medical emergency can it trigger?

A

Asthma attack

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27
Q

What is complete control of asthma defined as? (5)

A
  1. No daytime symptoms
  2. No night-time waking due to asthma
  3. No asthma attacks
  4. No need for rescue medication
  5. Normal lung function
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28
Q

Which FEV1/Peak flow i considered to be normal lung function?

A

Over 80%

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29
Q

Which lifestyle advice can be given to people with asthma? (3)

A
  1. Weight loss
  2. Smoking cessation
  3. Breathing exercises
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30
Q

Before stepping up treatment for asthma, what must you first check? (3)

A
  1. Compliance
  2. Inhaler technique
  3. Triggers
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31
Q

What is the first step of treatment for mild or intermittent asthma?

  1. What is step 4?
A

STEP 1: Inhaled SABA PRN

    • LABA
  2. Increase dose ICS / + LRA / + MR Theophylline + MR oral BA
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32
Q

Asthma: When should the patient be moved on to step 2? (3)

A
  1. Using the inhaler >3 times a week
  2. Any night time symptoms
  3. Asthma attack within the last 2 years
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33
Q

Asthma: What is step 2?

A

STEP 2: SABA PRN + Regular ICS

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34
Q

Asthma: What is step 3?

A

STEP 2: SABA PRN + Regular ICS + Regular LABA

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35
Q

Asthma: What are the options for step 4? (4)

A

STEP 4:

  1. Increase dose ICS
  2. Leukotriene receptor antagonist
  3. MR Theophylline
  4. MR Oral beta agonist
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36
Q

Asthma: What is step 5?

A

STEP 5:

Regular oral steroids

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37
Q

Which drugs can be used as inhaled SABA? (STEP 1) (2)

A
  1. Salbutamol

2. Terbutaline

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38
Q

Which drugs can be used as ICS? (STEP 2) (4)

A
  1. Beclometasone
  2. Budesonide
  3. Mometasone
  4. Fluticasone
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39
Q

What is the ICS dose for a child 5-12?

A

200-400mcg/day

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40
Q

What is the ICS dose for an adult?

A

400-800mcg/day

41
Q

Which drugs can be used as inhaled LABA? (STEP 3) (2)

A
  1. Formetarol

2. Salmetarol

42
Q

What should be done if a person is going through more then one SABA a month?

A

Urgent assessment

43
Q

Is a LABA included in the management of asthma for children under 5?

44
Q

Asthma >5: What is step 1?

A

STEP 1: SABA PRN

45
Q

Asthma >5: What is step 2?

A

STEP 2: Regular ICS

46
Q

Asthma 2-5: What is step 3?

A

STEP 3: Monteleukast

47
Q

Asthma >5: What is step 4?

A

STEP 4: Referral to peadiatrician

48
Q

Asthma <2: What is step 3?

A

STEP 4: Referral to peadiatrician

49
Q

Which side effects are associated with using ICS in children? (3)

A
  1. Adrenal suppression
  2. Low BMD
  3. Growth failure
50
Q

If asthma treatment is to be stepped down, what do they recommend to continue?

A

Regular ICS

51
Q

If asthma treatment is to be stepped down, how often should this be done and by how much?

A

Every 3 months, 25-50% dose reduction each time

52
Q

What is the drug of choice in exercise induced asthma? When should it be used?

A

SABA

Immediately before

53
Q

What is the peak flow of moderate acute asthma?

A

> 50-75% of best

54
Q

As well as inability to complete sentences in one breath, What is the peak flow of severe acute asthma?

A

33-50% of best

55
Q

As well as inability to complete sentences in one breath, What is the respiratory rate of severe acute asthma?

56
Q

As well as inability to complete sentences in one breath, What is the heart rate of severe acute asthma?

57
Q

What is the peak flow and oxygen of life-threatening acute asthma?

A

<33%, <92%

58
Q

What is the characteristic of near fatal acute asthma?

A

Raised carbon dioxide requiring mechanical ventalation

59
Q

In acute asthma, which patients can be treated at home?

60
Q

In acute asthma, which patients need to be admitted to hospital?

A

Severe or life threatening

61
Q

Which level of oxygen should we try to maintain in patients with acute asthma?

62
Q

What is first line treatment for non life threatening acute asthma?

A

pMDI SABA given through a spacer

63
Q

What is first line treatment for life threatening acute asthma?

A

SABA given through a nebuliser

64
Q

In acute asthma, how long should a patient be prescribed oral prednisolone?

A

For 5 days or until recovery

65
Q

In severe acute asthma, which 2 drugs are an option to be used only after recommendation by senior staff?

A
  1. IV Magnesium sulfate

2. IV Aminophylline infusion

66
Q

In acute asthma, how long should a child over 2 be prescribed oral prednisolone?

67
Q

How soon after an asthma attack should the GP be informed? They need to do a review and come up with an action plan

A

24 hours after discharge

68
Q

Why is ephedrine a less suitable broncodilator compared with salbutamol or terbutaline?

A

Less selective, associated with arrhythmias

69
Q

What are the indications for adrenaline?

A
  1. Anaphylaxis
  2. Severe croup
  3. Angiodema
  4. Cardiopulmonary ressus
70
Q

With which other drug should LABAs be used?

A

Only if the patient regularly used an ICS

71
Q

Which LABA should not be used in asthma attacks due to its long onset?

A

Salmetarol

72
Q

What effect does theophylline have on electrolytes?

A

Causes hypokalaemia

73
Q

What effect can beta 2 agonists have on electrolytes?

A

Cause hypokalaemia

74
Q

In people using beta 2 agonists, which concomittant medicines may result in hypokalaemia? (3)

A
  1. Theophylline
  2. Diuretics
  3. Corticosteroids
75
Q

What should be monitored in patients with severe asthma?

A

Potassium - risk of hypokalaemia

76
Q

Which asthma broncodilator should be discontinued if there is no benefit?

A

LABA - formetarol or salmetarol

77
Q

If a previously effective SABA fails to provide relief for at least how long should the patient be advised to contact their doctor?

78
Q

A trial of ICS are used for 3-4 weeks to help distinguish asthma from COPD. If there is a clear improvement after 3-4 weeks, what does this suggest?

79
Q

How are ICS effective in asthma?

A

Reduce airway inflammation, reduce oedema and secretion of mucous in the airway

80
Q

What reduces the efficacy of ICS?

A

Current or previous smoking

81
Q

How long after initiation does it take for symptoms to be alleviated with ICS?

82
Q

Which LABA + ICS combination inhalers can be used as a reliever for patients struggling with SABA alone? (2)

A
  1. Symbicort

2. Fostair

83
Q

Does the dose of an oral steroid need to be tapered if high doses are used short-term for an acute asthma attack?

84
Q

At what time of day should an oral steroid be taken to reduce effect on normal circadian rhythm?

85
Q

Is a patient develops oral thrush while using an ICS, what are the options?

A
  1. Counselling on rinsing mouth out after administration
  2. Using a spacer device
  3. Antifungal oral suspension or gel
86
Q

Is a patient develops oral thrush while using an ICS, does it need to be stopped?

87
Q

Which ICS should be prescribed by brand as they are not interchangeable?

A

QVAR and Clenil Modulite - QVAR is twice as potent

88
Q

What should be issued to patients with high doses of beclometasone?

A

Steroid card

89
Q

How would you describe the particles in fostair?

A

Extra fine - if switching from a non-extra-fine inhaler, half the dose

90
Q

Why can toxicity of aminophylline and theophylline be delayed?

A

Often prescribed as modified release preparations

91
Q

What are the symptoms of aminophylline toxicity? (6)

A
  1. Vomiting
  2. Agitation
  3. Restlessness
  4. Dilated pupils
  5. Sinus tachycardia
  6. Hyperglycaemia
92
Q

Why is plasma-theophylline monitoring essential?

A

To avoid loading patients already taking it with more as side effects of convulsions and arrythmias often preced other signs of toxicity

93
Q

What should the level of plasma theophylline be?

A

10-20mg/L, 5-15mg/L may also be effective

94
Q

At which plasma theophylline level do we start to see severe adverse effects?

95
Q

How long after starting IV aminophylline treatment should a plasma theophylline level be taken?

96
Q

If a patient is taking oral theophylline treatment, how long after they start should a plasma level be taken?

A

5 days after

97
Q

Should patients already taking oral theophylline or aminophylline receive a loading dose of aminophylline?

98
Q

How much theophylline be prescribed?

BNF (28 decks)

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