Clinical Study 1, Patient B Flashcards
When should a low dose of ICS be offered as first-line maintenance therapy to adults (17 and over)?
When symptoms at presentation clearly indicate the need for maintenance therapy (for example, asthma-related symptoms 3 times a week or more, or causing waking at night)
or the asthma is uncontrolled with a SABA alone.
If asthma is uncontrolled in adults on a low dose of ICS as maintenance therapy, what should be offered in addition to the ICS?
Leukotriene receptor antagonist (LTRA) such as montelukast or zafirlukast.
Review the response to treatment in 4 to 8 weeks.
If asthma is uncontrolled in adults on a low dose of ICS and an LTRA as maintenance therapy, what should be offered in combination with the ICS?
A long-acting beta2 agonist (LABA) and the LTRA treatment should be reviewed.
Discuss with the person whether or not to continue LTRA treatment, take into account the degree of response to LTRA treatment.
If asthma is uncontrolled in adults on a low dose of ICS and a LABA, with or without an LTRA, as maintenance therapy, what should be offered?
Should offer to change a persons ICS and LABA maintenance therapy to a MART regimen with a low maintenance ICS dose.
If asthma is uncontrolled in adults on a MART regimen with a low maintenance ICS dose, with or without an LTRA, what should be considered?
Consider increasing the ICS to a moderate maintenance dose (either continuing on a MART regimen or changing to a fixed-dose of an ICS and a LABA, with a SABA as a reliever therapy).
If asthma is uncontrolled in adults on a moderate maintenance ICS dose with a LABA (either as MART or a fixed-dose regimen), with or without an LTRA, what should be considered?
Increasing the ICS to a high maintenance dose (this should only be offered as part of a fixed-dose regimen, with a SABA used as a reliever therapy) or
A trial of an additional drug (for example, a long-acting muscarininc receptor antagonist or theophylline).
What is theophylline?
Methylxanthine drug used in therapy for respiratory diseases such as COPD and asthma.
It bears structural similarity to theobromine and caffeine.
What are the main actions of theophylline? [6]
- Relaxing bronchial smooth muscle
- Increasing heart muscle contractility and efficiency; as a positive inotrope
- Increasing blood pressure
- increasing renal blood flow
- anti-inflammatory effects
- Central nervous system stimulatory effects mainly on the medullary respiratory centre.
What are the four main therapeutic uses of theophylline?
COPD
Asthma
Infant apnea
Blocks the action of adenosine; an inhibitory neurotransmitter that induces sleep, contracts the smooth muscles and relaxes the cardiac muscle.
What dose adjustments for theophylline exist?
If smoking started or stopped during treatment.
The plasma-theophylline concentration is increased in what circumstances?
Theophylline is metabolised in the liver. The plasma-theophylline concentration is increased in heart failure, heparic impairment, and in viral infections.
The plasma-theophylline concentration is decreased in what circumstances?
In smokers, and by alcohol consumption.
What is the main electrolyte imbalance as a result of theophylline use?
Potentially serious hypokalaemia may result from beta2 agonist therapy. Particular caution is required in severe asthma, because this effect may be potentiated by concomitant treatment with theophylline and its derivatives, corticosteroids, and diuretics, and by hypoxia.
Plasma-potassium concentration should therefore be monitored in severe asthma.
What are the signs of theophylline overdose?
Vomiting (which may be severe and intractable), agitation, restlessness, dilated pupils, sinus tachycardia, and hyperglycaemia.
More serious effects are haematemesis, convulsions, and supraventricular and ventricular arrhythmias. Severe hypokalaemia may develop rapidly.
In most patients, a plasma-theophylline concentration of what is required for satisfactory bronchodilation?
10-20mg/litre (55-110micromol/litre) is required.
Although a lower plasma-theophylline concentration of 5-15mg/litre may be effective.
