Chronic asthma Flashcards
define asthma
Common chronic inflammatory condition of the Airways, associated with airway hyper responsiveness and variable airflow obstruction
what is asthma-COPD overlap syndrome
characterised by persistent airflow limitation displaying features of both asthma and COPD
complete control of asthma is defined by
- no daytime symptoms
- no night time awakening due to symptoms
- no asthma attacks
- no need for rescue med
- no limitations on activity including exercise
- normal lung function (i.e. FEV1 and/or PEF >80% predicted or best)
- minimal SE from treatment
One of the factors for complete control of asthma includes normal lung function. What does this mean in practical terms (FEV1 and/or PEF)
FEV1 and/or PEF >80% predicted or best
What is FEV1 and PEF
FEV1 = forced expiratory volume in one second
PEF = peak expiratory flow
true or false - weight losss in overweight pt may lead to improvement in asthma symptoms
true
for people with infrequent short lived wheeze, what is treatment
occasional use of reliever therapy may be the only treatment required
if a patient is using …. SABA inhaler a month they need their asthma urgently assessed and action taken to improve poorly controlled asthma
more than 1 device
adults - start low dose ICS as regular maintenance therapy in patients who present with
waking up at night from asthma symptoms at least once a week
OR
using SABA 3 times a week or more
OR
symptomatic 3 times a week or more
when you give montelukast (LTRA) in adults or children, when should you review response to treatment
in 4-8 weeks
Name some beclomethasone and formoterol MART inhalers
Foster, Luforbec
Name some budesonide & formoterol MART inhalers
symbicort
duoresp
wockair
fobumix
Mabs and immunosuppressants are specialist therapies. Name 5 Mabs and 1 immunosuppressant and explain when they can be used
Omalizumab, mepolizumab, benralizumab, reslizumab, dupilumab
Can be ocnisdred in certain pt with severe asthma to achieve control and reduce use of oral CCs
Immunosuprpesants e.g. MTX (unlicensed) may also be considered as recommended by BTS/SIGN
name two Mabs and 1 immunosuppressant that can be considered in children
Monoclonal antibodies such as omalizumab and dupilumab can be considered in certain children with severe asthma to achieve control and reduce the use of oral corticosteroids; immunosuppressants such as methotrexate [unlicensed] may also be considered as recommended by BTS/SIGN (2019).
For children UNDER 5, what steps would you take if a patient who has SABA as reliever presents with
- asthma symptoms 3x a week or more
- night time awakening at least once a week
- suspected asthma that is uncontrolled using SABA alone
- consider 8 week trial of paediatric MODERATE dose ICS
- after 8 weeks, stop ICS and monitor symptoms
- if symptoms did NOT resolve during trial, review for alternative diagnoses
- if symptoms resolved then reoccured within 4 weeks of stopping ICS, restart ICS at paediatric LOW dose as 1st line maintenance therapy
- if symptoms resolved but reoccured BEYOND 4 weeks after stopping ICS, repeat 8 week trial of paediatric MODERATE dose ICS
If suspected asthma is uncontrolled in children UNDER 5 who are on 1st line paediatric LOW Dose ICS as maintenance, what can you consider in addition to ICS?
LTRA
If suspected asthma is uncontrolled in children aged under 5 years on a paediatric low-dose of ICS and a LTRA as maintenance therapy, what do you do?
stop the LTRA and refer the child to an asthma specialist.
When can you consider decreasing maintenance therapy? Which drug?
asthma has been controlled with their current maintenance therapy for at least 3 months.
when deciding which drug to decrease first and at what rate, consider pt pref; severity of asthma; SE treatment; duration on current dose; beneficial effect achieved.
ensure to regularly review pt when decreasing treatment.
decreasing treatment of ICS - when should you consider dose reductions, and at what rate
- should be maintained at lowest possible dose of ICS
- consider reductions every 3 months, decreasing dose by ~ 25-50% each time
- reduce dose SLOWLY as pt deteriorate at different rates
only consider stopping ICS treatment for patients who are…
using a paediatric or adult low-dose ICS alone as maintenance therapy and are symptom-free.
true or false - for most pt, exercise induced asthma is an illustration of poorly controlled asthma and regular treatment including ICS should therefore be reviewed
True.
If exercise is a specific problems in pt already taking ICS who are otherwise well controlled, what is step up treatment you can consider
Cnsider adding either a LTRA, a LABA, sodium cromoglicate or nedocromil sodium, or theophylline.
A SABA used immediately before exercise is the drug of choice.
Can asthma medication be used as normal during pregnancy? Which ones ?
SABAs
LABAs
oral and inhaled CCs
sodium cromoglicate
nedocromil sodium
oral and IV theophylline
LTRA - limited info, but do not withhold where indicated to achieve adequate control
Define what paediatric low dose is (budesonide)
less than or equal to 200mcg budesonide or equivalent
define what paediatric moderate dose is (budesonide)
more than 200mcg to 400mcg budeosnide or equivalent
define paediatric hig dose ICS (budesonide)
> 400mcg budesonide or equivalent
pMDI beclomethasone - what is paediatric low, medium and high dose?
low: 100mcg 2 puffs BD
medium: 200mcg, 2 puffs BD
high: 200mcg, 4 puffs BD
a 7 yr old is currently on the following inhalers for asthma. Clenil 100mcg 2 puffs BD and Ventolin evohaler 2 puffs up to 4 times a day PRN. They are still having to use their reliever inhaler more than 3 times a week, therefore their asthma is not controlled. What is the next step in treatment.
Add montelukast, 5mg OD, dose be taken in the evening.
review response in 4-8 weeks
Doses of montelukast for prophylaxis of asthma
6 months - 5 yrs: 4mg OD in evening
6 yrs - 14 yrs: 5mg OD in evening
15-17 yrs and adults: 10mg OD in evening
dose of montelukast for 5 yr old
4mg od in evening
dose of montelukast for 14 year old
5mg od in evening
A 8 yr old is currently taking the following for asthma, but asthma is still uncontrolled so what is the next step.
Clenil 100mcg 2 puffs BD (low dose paediatric)
Salamol 2 puffs QDS prn
Montelukast 5mg take one at night
Consider stopping montelukast and start LABA alongside ICS as maintenance therapy (e.g. formoterol, salmeterol)
A 9 yr old is takin the following for asthma but it is still uncontrolled, what do you do
Clenil 100mcg 2 puffs bd (low paediatric ICS)
Salmeterol 50mcg, one puffs BD
Consider changing to MAR - combination of paediatric low dose ICS and LABA
e.g. symbicost 100/6 turbohaler 1-2 puffs BD, reduce to 1 puff daily if control maintained
What is the ONLY MART inhaler that is licensed for children from 6-17 (the rest of 12-17)
Symbicort 100/6 turbohaler for maintenance therapy of asthma (Not reliever)
