Lecture 5 - management of asthma in patients Flashcards
what is asthma?
a condition due to inflammation of the air passages in the lungs and affects the sensitivity of the nerve endings in the airways so they become easily irritated. In an attack, the lining of the passages swell causing the airways to narrow and reducing the flow of air in and out of the lungs
what are the aims of asthma complete control ?
No daytime symptoms
No night-time wakening due to asthma
No need for rescue medication
No asthma attacks
No limitations on activity including exercise
Normal lung function (defined as PEFR >80% predicted or best)
Minimal side effects from medication
what is needed to be done before initiating new therapy?
Check adherence with existing therapies
Check inhaler technique
Eliminate trigger factors
what is asthma management treatment in adults?
monitored initiation of treatment with low dose of ICS
lo dose ICS - regular preventer
initial add on therapy - add inhaled LABA to low dose ICS
additional controller therapies - consider increasing ICS to medium dose, or adding LTRA. if no response to LTRA, then consider stopping it
specialist therapist - refer patient
what is asthma treatment in children ?
monitored initiation of treatment with low dose of ICS
regular preventer - very low dose ICS or LTRA <5 YEARS
initial add on therapy - very low dose ICS plus: children aged >5-add inhaled LABA or LTRA and children <5 add LTRA
additional controller therapies - consider increasing ICS to low dose, or children >5 add ultra or lava. if no response to lab consider stopping it
specialist therapies - refer
what devices are used for acute asthma?
pMDI + spacer with doses titrated
what is used for stable asthma?
pMDI + spacer as effective as any other hand held inhaler (5 – 12)
pMDI + spacer as effective as other device but patient may prefer some types of DPI (adults)
scribe symtoms, markers and actions for poorly controlled asthma
Patients with symptoms:
Wheeze
Cough (particularly at night)
Poor exercise capacity
Prescribing markers:
Using more than one SABA inhaler a month
Actions:
Check inhaler technique
Check compliance with inhaled medicines
Any trigger factors
Increasing therapy
describe well controlled asthma symptoms and actions for it
No daytime symptoms
No night-time wakening due to asthma
No need for rescue medication
No asthma attacks
No limitations on activity including exercise
Normal lung function (defined as PEFR >80% predicted or best)
For six months
Consider reducing therapy
Evidence only available for reducing dose of ICS
