L3W1 BA Management

Question 1

Goals of BA treatment? (4)

Answer 1

1. Control of BA(symp, pulmo fx)
2. Dec/prevent comp asthma
3. Dec mortality asthma
4. Dec se & mortality from drugs use

Question 2

Asthma Treatment depend on? (4)

Answer 2

1. Severity asthma
2. Pt current treatment
3. Economic considerations
4. Drug availability

Question 3

Sympathomimetics(BA)? (short/long)

Answer 3

1. Short acting
   - Salbutamol,Terbutaline, Fenotero
2. Long acting
   - Salmetrol, Formetrol, Bambuterol, Olodaterol, Indacaterol

Question 4

Parasympatholytic?(short/long)

Answer 4

1. Short acting
   - Ipratropium bromide
2. Long acting
   - Glycopyrronium, Tiotropium

Question 5

Theophylline

Answer 5

• Inhibit phosphodiestrase-> accumulation cAMP in Sm Ms

- Rare use nowadays

Question 6

Antiinflammatory drugs? (6)

Answer 6

1. Steroids:
A) Inhaled
-Beclomethasone, Budesonide, Flutecasone, Ceclesonide
B) Systemic: parenteral/oral
-Prednisolone, Betasone, Dexasone
2. Antileukotreins: 
-montelukast, xafirlukast
3. Anti-IgE:
-omalizumab
4. Steroid sparing drugs:
-azathioprine, methotrexate, cyclosporine A
5. Anti IL5
6. Anti IL13

Question 7

Asthma severity grades(severity/day/night/fev1%)

Answer 7

• Intermittent(≤2 d/w, ≤2n/m, ≥80%)
• Mild(>2/w, 2n/m, ≥80%)
• Moderate(daily, >1n/w, 60-80%)
• Severe(cont, frequent, ≤60%)

Question 8

Stepwise for Asthma? (5 steps)

Answer 8

Step 1
-Low ICS, SABA if needed
Step 2
-Medium ICS + LABA, LRA, theophylline
Step 3
-High ICS + LABA, LRA, theophylline
Step 4
-High ICS + LABA, LRA, theophylline, Sys low steroid
Step 5
-High ICS + LABA, LRA, theophylline, sys low steroid, tiotropium, Anti IGE

Question 9

Def ASA?

Answer 9

Wheezing which not respond to initial treatment with inhaled bronchodilator

Question 10

CP ASA(6)

Answer 10

1. Pulse: >130/min
2. RR: >30/min
3. Intercostal indrowing
4. Cyanosis
5. Unable to complete a sentence
6. Pulsus paradoxicus

Question 11

Ttt ASA(7)

Answer 11

1. Open IV line
2. O2 inhalation
3. 200mg hydrocortisone
4. IV theophylline slowly(30min)
5. Inhaled salbutamol w/wo ipratropium(nebulizer)
6. Inhaled high doses budesonide(nebulizer)
7. Mechanical ventilation if pt:
   - Exhausted, Hypercapnea.

Question 12

Ttt job asthma(3)

Answer 12

1. Change work environment
2. Desensitization if not possible
3. LABA + ICS + LTRA

Question 13

CP AIA(triad)

Answer 13

1. Asthma,
2. Chronic rhinosinusitis w nasal polyps
3. Precipitation asthma & rhinitis att(aspirin & other NSAID)

Question 14

Ttt AIA(4)

Answer 14

1. Inhaled corticosteroids,
2. Beta(2)-adrenoceptor agonists
3. LT modifiers
4. COX2 inh

Question 15

ATS workshop(major ≥1, minor 2)

Answer 15

• Cont/near-cont oral steroid
• High-dose ICS
• Additional daily controller
• Use SABA daily
• Persistent airway obs
• FEV1 <80%
• Diurnal variation in PF ≥ 25%
• ≥ 1 urgent care visit per year
• ≥3 steroid bursts per year
• Prompt deterioration w 25% reduce steroid dose
• Episode of near-fatal asthma

Question 16

CP EIA(7)

Answer 16

1. Coughing
2. Wheezing
3. Shortness of breath
4. Chest tightness/pain
5. Fatigue during exercise
6. Poor athletic performance
7. Avoid activity (young children)

Question 17

Ttt EIA(6)

Answer 17

1. Warming
2. SABA 15min before exercise
3. Ipratropium bromide 15min before exercise
4. Inhaled corticosteroids
5. Combination: LABA + ICS
6. Leukotriene modifiers

Question 18

Treatment of eosinophilic asthma

Answer 18

Target Th2(allergic) asthma

Question 19

Treatments based on Phenotypes - Omalizumab

Answer 19

• High IgE
• Known Allergen
• BMI

Question 20

Treatments based on Phenotypes - Mepolizumab

Answer 20

• High Eosinophils
• > =2 exacerbations/yr
• On high dose ICS

Question 21

Se Omalizumab & Mepolizumab

Answer 21

Omalizumab
-anaphylaxis, malig, pain & arthralgia, inj site bruise/pain
Mepolizumab
-ms pain, fatigue, inj site bruise/pain