Lecture 5: Management of patients with asthma

Question 1

Define asthma

Answer 1

Asthma attacks all age groups but often starts in childhood. It is a disease characterized by recurrent attacks of breathlessness and wheezing, which vary in severity and frequency from person to person. In an individual, they may occur from hour to hour and day to day. This condition is 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

Question 2

What is the aim of asthma therapy?

Answer 2

Achieve early control and maintain this by stepping up when necessary and stepping down treatment when control is good

• No daytime symptoms
• No night-time wakening due to asthma
• No need for rescue medication (SABA)
• No asthma attacks
• No limitations on activity including exercise
• Normal lung function (defined as PEFR >80% predicted or best)
• Minimal side effects from medication

Question 3

What needs to be considered before initiating new therapy?

Answer 3

• Check adherence with existing therapies
• Check inhaler technique
• Eliminate trigger factors

Question 4

What should you offer to people with newly diagnosed asthma or asthma that is uncontrolled?

Answer 4

Offer a SABA as reliver to adults (17 and over)

Question 5

What should you give to adults (aged 17 and over) with asthma who have infrequent, short-lived wheeze and normal lung function

Answer 5

Treatment with SABA reliever therapy alone

Question 6

What should you give to adults with symptoms at presentation that clearly indicate the need for maintenance therapy (for example, asthma-related symptoms 3 times a week or more, or causing waking at night) or asthma that is uncontrolled with a SABA alone.

Answer 6

Low dose of an ICS as the first-line maintenance therapy

Question 7

What is given for uncontrolled asthma in adults on a low dose of ICS as maintenance therapy?

Answer 7

Offer a leukotriene receptor antagonist (LTRA) in addition to the ICS and review the response to treatment in 4 to 8 weeks

Question 8

What is given for uncontrolled asthma in adults (aged 17 and over) on a low dose of ICS and an LTRA as maintenance therapy

Answer 8

Offer a long-acting beta2 agonist (LABA) in combination with the ICS, and review LTRA treatment as follows

Question 9

What is given to patients if asthma is uncontrolled in adults (aged 17 and over) on a low dose of ICS and a LABA, with or without an LTRA, as maintenance therapy?

Answer 9

ffer to change the person’s ICS and LABA maintenance therapy to a MART regimen with a low maintenance ICS dose.

Question 10

What is offered to 5-16 year olds with newly diagnosed asthma?

Answer 10

SABA as reliever therapy

Question 11

What is given to children and young people (aged 5 to 16) with asthma who have infrequent, short-lived wheeze and normal lung function?

Answer 11

Treatment with SABA reliever therapy alone.

Question 12

What is given to 5-16 year olds with symptoms at presentation that clearly indicate the need for maintenance therapy (for example, asthma-related symptoms 3 times a week or more, or causing waking at night) or asthma that is uncontrolled with a SABA alone?

Answer 12

paediatric low dose of an ICS as the first-line maintenance therapy

Question 13

What is given to 5-16 year olds if asthma is uncontrolled and on a paediatric low dose of ICS as maintenance therapy?

Answer 13

Consider an LTRA in addition to the ICS and review the response to treatment in 4 to 8 weeks

Question 14

What are the symptoms of poorly controlled asthma?

Answer 14

• Wheeze
• Cough - usually at night
• Poor exercise capacity

Question 15

What actions should be taken in patients with poorly controlled asthma?

Answer 15

• Check inhaler technique
• Check compliance with inhaled medicines
• Establish any trigger factors

Question 16

Describe inhalation route

Answer 16

This route delivers the drug directly to the airways; the dose required is smaller than when given by mouth and side-effects are reduced.

Question 17

What do inhaler devices include?

Answer 17

• pressurised metered-dose inhalers
• breath-actuated inhalers
• dry powder inhalers.

Question 18

What are spacer devices?

Answer 18

Remove the need to co-ordinate actuation with inhalation.

Question 19

When should a spacer be used?

Answer 19

Should always be used if the patient is on a high dose of inhaled corticosteroid.

Question 20

Why do brand and inhaler need to be specified when prescribing?

Answer 20

To help reduce confusion and ensure patients receive inhalers they have been given training for

Question 21

What does a nebuliser do?

Answer 21

Converts a solution of a drug into an aerosol for inhalation. It is used to deliver higher doses of drug to the airways than is usual with standard inhalers

Question 22

What lifestyle changes should be offered to patients with asthma?

Answer 22

• Weight loss in overweight patients may lead to improve
• Breathing exercise programmed can be offered to improve quality of life and reduce symptoms
• Advise about the dangers of smoking

Question 23

What is intermittent reliever therapy?

Answer 23

Start an inhaled short-acting beta2 agonist (such as salbutamol or terbutaline sulfate),

Question 24

What is regular preventer maintenance therapy?

Answer 24

A low-dose of inhaled corticosteroid (ICS) should be started as maintenance therapy in patients who present with any one of the following features: using an inhaled short-acting beta2 agonist three times a week or more, symptomatic three times a week or more, or waking at night due to asthma symptoms at least once a week.

Question 25

Name the monoclonal antibodies?

Answer 25

• Omalizumab
• Mepolizumab
• Benralizumab
• Reslizumab
• Dupilumab