Chronic Asthma- ICS DI

Question 1

ICS drugs

Answer 1

Ciclesonide
Fluticasone
Beclomethasone
Mometasone
Budesonide

Question 2

ICS MoA

Answer 2

Reduces chronic airway inflammation, reduces risk of exacerbations, improves lung function, reduces symptoms, and improves QoL

Question 3

Avoid DPIs in what age group?

Answer 3

<4 years

Question 4

What should you do to MDIs before use?

Answer 4

Shake them

Question 5

What should you NOT do to DPIs before use?

Answer 5

Shake them

Question 6

Avoid DPIs in what allergy?

Answer 6

Milk protein (they contain lactose)

Question 7

The only DPI an asthmatic patient with a milk protein allergy can use

Answer 7

Budesonide

Question 8

ICS dosing

Answer 8

Use the lowest dose possible

Question 9

ICS step-down dosing

Answer 9

Lower the dose by 25-50% if asthma is well-controlled after a 3-month stability period

Question 10

Most common ICS side effects and how to manage them

Answer 10

Oral thrush and dysphonia, rinse mouth with water and spit out after use or use chambers/spacers for MDIs

Question 11

Other ICS side effects

Answer 11

Growth concerns with higher doses

Hyperglycemia and increased fracture risk at higher doses with chronic, long-term use

Question 12

Avoid ICSs in what disease states?

Answer 12

Acute bronchospasm and status asthmaticus

Question 13

What are ICSs used for?

Answer 13

Maintenance therapy (first-line options!)