January 15, 2016 - Asthma Management

Question 1

Current Drugs for Asthma

Answer 1

Short-acting ß₂-andrenoceptor agonists (SABA)

Inhaled corticosteroids (ICS)

Long-acting ß​₂-andrenoceptor agonists (LABA)

Leukotriene receptor antagonists (LTRA)

Anti-IgE monoclonal antibodies

Oral corticosteroids (try to avoid)

Question 2

Relievers

Answer 2

“Rescue medications”

Activates ß​2-andrenoceptors on airway’s smooth muscle to quickly relieve symptoms in 1-2 minutes, but are short acting (2-6 hours).

Examples are SABAs such as Salbutamol (Ventolin®).

These are not for regular prophylactic use.

Question 3

ß​2-Andrenoceptor Agonists

Answer 3

Work by relaxing bronchial smooth muscle irrespective of the spasmogen.

These act as “functional antagonists” regardless of what caused the provocation, and these are very effective.

Question 4

Side Effects of ß​-Agonists

Answer 4

SABAs are well-tolerated, but some minor side effects include tremors, tachycardia, and tachyphylaxis.

LABAs are the same as above.

Question 5

Controllers

Answer 5

Used regularly for phophylaxis.

Include inhaled corticosteroids (ICS), ICS/LABA combinations, and leukotriene receptor antagonists (LTRA).

The anti-inflammatory effect has a slow onset of 1-3 hours, but has a long duration of action of 12-24 hours.

* Controllers are indicated if there is any sign of poor control. *

Question 6

When Controllers are Indicated

Answer 6

If there is any signs of poor control.

Question 7

Controlled Asthma Criteria

Answer 7

Daytime symptoms of <4 days a week

Nighttime symptoms <1 night a week

Physical activity is normal

Excaberations are mild and infrequent

Absence from work or school - none

Need for SABA <4 doses a week

FEV1 is >90% of personal best

PEF diurnal variation is <10-15%

Question 8

Side Effects of Inhaled Corticosteroids (ICS)

Answer 8

Because of the oropharyngeal deposition, the patient may experience hoarseness, sore throat, or thrush.

Systemic effects for inhaled corticosteroids are not nearly as strong as with systemic corticosteroids, but high-doses of ICS in children may lower growth velocity and have a final height that is ~1cm shorter.

Question 9

Leukotriene Receptor Antagonists

Answer 9

Leukotrienes are potent bronchoconstrictors.

Leukotrienes cause inflammation and mucous secretions, therefore by adding antagonists this can help in patients with asthma.

These are typically used as an add-on therapy.

Question 10

Anti-IgE Therapy

Answer 10

Indications for use in patients who have moderate to severe asthma despite guideline care.

Have serum IgE between 30 and 700.