Chronic Asthma Flashcards
What is asthma?
Chronic reversible inflammatory condition of the airways
What causes asthma?
Type 1 hypersensitivity to allergens
Name some possible allergens/triggers of asthma.
- Dust
- Pet dander
- Cold/damp air
- Pollen
- Exercise
- Infection
- Emotions
What features of a presentation may indicate asthma?
- Episodic
- Diurnal variability (worse at night)
- Atopy history
- Family history
What features may point away from asthma?
- Wheeze is only present during infection (viral infection)
- Cough is productive
- Cough is isolated
- No response to normal treatment
- Wheeze is unilateral (suggests focal lesion or infection)
How is asthma diagnosed? (BTS guidelines)
- If high suspicion, clinical diagnosis is enough- trial treatment
- If moderate suspicion, spirometry with reversibility
- If low suspicion, refer for investigation of other causes
What are the first line investigations for asthma?
- Fractional exhaled nitric oxide
- Spirometry with bronchodilator reversibility
What other diagnostic tools are available?
- Peak flow variability, several times a day for 2-4 weeks
- Histamine/methacholine challenge
Outline steps 1-5 of the asthma pathway.
1- SABA 2- Low-dose ICS 3- LABA or LRA (BTS and NICE differ) 4- Other of either LABA/LRA or MART 5- LAMA/Referral
What are the aims of the ladder?
To have the least symptoms/daily restriction whilst on the lowest dose/least medications.
It should be reviewed regularly (at least annually) to step up and down.
Name a drug used in step one.
Salbutamol PRN
Name a drug used in step 2
Beclometasone (maintenance therapy)
Name a drug used in step 3
LABA- Salmeterol, formoterol
LRA- montelukast
What should you do if the LRA/LABA doesn’t work for the patient?
Stop it- do not use any medication that isn’t of benefit to the patient
Name a LAMA.
Tiotropium
How do LAMAs work?
- Block ACh receptors
- Stop parasympathetics from causing bronchoconstriction
How do LRAs work?
- Block the effects of Leukotrienes
- Leukotrienes cause inflammation, bronchoconstriction and mucous secretion
What is theophylline?
A drug that relaxes bronchial smooth muscle and reduces inflammation.
Narrow therapeutic window and is toxic in excess.
What is MART?
Maintenance and Reliever Therapy
- Low dose ICS and LABA combination
- One inhaler for the two drugs
When would you use a MART?
By step 5- often used instead of LRA and LABA
What additional conservative measures may be important in managing chronic asthma?
- Asthma plan
- Avoid allergens/triggers
- Annual flu vaccine
- Avoid smoking
- Yearly asthma review
