L 08 Therapy of Asthma

Question 1

What is EBM?

Answer 1

Evidence based medicine(EBM). The use of evidence from well designed research to optimise clinical decision making.( i.e. evidence based clinical practice.)

Question 2

EBM determines are the following basis:

Answer 2

Clinical Judgment
Relevant scientific evidence
Patients values and preferences

Question 3

What is asthma?

Answer 3

It is chronic airway inflammation.
Airflow limitation causes wheezing breathlessness, coughing.
Airway hyper responsiveness cause narrowing down the airways in response to triggers or allergen like pollen or dust.

Question 4

How much air reaches the alveoli?

Answer 4

About 67%

Question 5

How air moves into and out of the lungs?

Answer 5

Cyclical movement by contraction and relaxation or muscle through elastic recoil of connective tissue

Question 6

Where Obstructive disease e.g. asthma and COPD affect?

Answer 6

Affect in inspiratory rate.

Question 7

Where restrictive disease e.g. pulmonary fibrosis affect?

Answer 7

Inspiratory capacity

Question 8

What are the epidemiology of asthma for Maori hospitalised?

Answer 8

Around 3 time more likely to be admitted to hospital with asthma
Pacific 3.2 times more likely to be admitted to hospital with asthma

Question 9

What are the options available in nz to diagnose asthma?

Answer 9

There is no single GOLD standard available to identify asthma.
Identify the pattern of sign and symptoms
Differential diagnosis
Clinical history and clinical examination
By measuring expiratory airflow

Question 10

What are the signs and symptoms of asthma?

Answer 10

Cough
Wheezing
Shortness of breath 
Chest tightness
Unable to communicate
Worse at night 
Tachycardia
Hypoxia (Under 92% oxygen in blood)
Diaphoresis(sweeting)

Question 11

What is the main plan of asthma treatment?

Answer 11

Need to use drugs to increase ventilation
Use drugs to reduce inflammation
Use O2 to enrich Oxygenated blood when needed
Avoid triggers like pollen

Question 12

What is the main goal of asthma treatment?

Answer 12

Maintain long term control using least amount of medication and minimising adverse effects

Question 13

What are the non pharmacological treatment option for asthma?

Answer 13

Quit smoking or avoid smoky areas
Maintain regular physical activities and exercise
Avoid indoor and outdoor exposure to triggers e.g animal or mould or some food.
Avoid occupation exposure to triggers
Avoid medication that may trigger asthma attacks i.e some NSAIDs and some Beta blockers

Question 14

What are the pharmacological treatment options of asthma?

Answer 14

• B2 agonist SABA or LABA
	• Muscarinic antagonist SAMA and LAMA
	• Corticosteroids
	•  (LTRA) Leukotriene receptor antagonists
	• mAbs
	• Mast cell stabilisers
Methylxanthines

Question 15

What are the types of inhalers available in nz market for asthma?

Answer 15

MDI
DPI (Dry powder inhaler)
Soft mist inhaler(SMI)
Nebulizer

Question 16

What lab test can be MONITORED for asthma?

Answer 16

Can use for ACT (Asthma Control Test)

Question 17

What is the first line therapy for asthma?

Answer 17

For child: SABA (age of 12 or under) first line treatment who diagnosed asthma in nz
For adults: ICS /LABA
Now Anti-inflammatory reliever (AIR) therapy
Symbicort 200/6 or 100/6 mcg 1 puff prn

Remember this is not recommended if patient cant use turbuhaler
And remember that the Salmeterol and vilanterol are not fast onset

Question 18

What are the things we need to consider for asthma in children?

Answer 18

Inhaler technique
Corticosteroid use stigma
Inhaler use at school
Smoking status of household members

Question 19

Symptoms of airflow limitation?

Answer 19

Wheezing, breathlessness, chest tightness and coughing.

Question 20

What is the most common chronic disease of childhood?

Answer 20

Asthma

Question 21

How is asthma diagnosed?

Answer 21

No gold standard test.
Using a pattern of signs, symptoms and ruling out differential diagnoses.
Clinical history and examinations are made.
Measuring PEFR too.

Question 22

PEFR is dependent on

Answer 22

Sex, age, height etc

Question 23

Non pharmacological asthma treatments

Answer 23

Avoid triggers
Quit smoking
Maintain regular exercise
Get flu vaccine

Question 24

Pharmacological treatment options for asthma (7x drug classes)

Answer 24

• B2 agonists (SABA, LABA)
• Muscarinic antagonists (SAMA, LAMA)
• Corticosteroids (inhaled and systemic)
• Leukotriene receptor antagonists
• Antibody therapy
• Mast cell stabilisers
• Methylxanthines

Question 25

Monitoring of asthma

Answer 25

Asthma control test (tickbox test)

Question 26

What is the standard of NEW treatment options of treating asthma

Answer 26

NEW:
ICS/LABA combination
(e.g Symbicort 200/6 or 100/6 = 1 puff prn) is first-line for teens and adults who can use a Turbuhaler.

(ICS=>inhaled corticosteroids)

Old: SABA prn + ICS added if req

Question 27

If ICS/LABA not giving adequate control what should you do?

Answer 27

ICS dose can be increased e.g Symbicort 400/12.

Also check turbuhaler technique