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PMP 201 Patient-Centred Learning > Management of Asthma > Flashcards

Management of Asthma Flashcards

1
Q

Making a diagnosis of asthma in children

A
  • Does the child present with symptoms of cough wheezing breathlessness and chest tightening
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2
Q

High probability: Structural and clinical assessment looking at history

A
  • Reoccouring episodes of symptoms
  • Symptom variability
  • Absence of symptoms and symptoms and alternative diagnosis
  • Observations of wheezing
  • Personal history of atopy
  • Historical record of PEF and FEV
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3
Q

Good response

Initiation of treatment after high probability asthma

A
  • Response is assessed objectively - Lung function validated symptom score
  • Definate asthma adjustment and maintainance of dose arrange ongoing review
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4
Q

Poor score on Assess response objectively (lung function and validated score system)

A
  • Intermediate probability of asthma
  • Test for airway disruption by spiromitry and bronchodialator
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5
Q

Test to investigate airways obstruction

A
  • Reversibility
  • PEF charting
  • Challenge tests
  • FeNO
  • Eosinophils
  • Skin prick test and IgE
  • Wait till good response
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6
Q

Low probability asthma diagnosis

A
  • Investigate and treat other more likely diagnosis
  • If other diagnosis unlikely test forairways obstruction
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7
Q

Adults and >17

Suspected asthma treatment

A
  • Concider monitored initiation of treatment with low ICS
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8
Q

Adults and >17

Regular preventer asthma diagnosed

A
  • Low dose ICS used
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9
Q

adult

Initial add on therapy for diagnosed asthma

A
  • Add inhaled LABA to ICS use fixed dosage
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10
Q

adult

Additional controller therapy

A
  • Concider icreasing ICS to medium dose or addin LTRA
  • If no response to LABA concider stopping
  • Additionally refer to specialist care
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11
Q

Child

Treatment control therapy

A
  • Last resort continue pediatric moderate dose of ICS with trial of additional drug
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12
Q

Uncontrolled asthma

A
  • Asthma that has a impact on persons quality of life
  • 3 or more days a week with symptoms
  • 3 or more days required use of SABA for symptomatic relief
  • 1 or > nights a week with awakening due to asthma
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13
Q

Maintainance and reliever therapy (MART)

A
  • One preventer and one reliever inhaler
  • Inhaled steroid + long acting brochodialator with fast onset action
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14
Q

Usage of MART inhaler

A
  • Daily maintainance and relief inhaler
  • Appropriate for low dose ICS step 2 & 3 and medium dose step 4
  • Person with personalised asthma action plan
  • Person that is able to self manage & compliant with treatment
  • Only treatment that is uncontrolled with ICS, LABA and SABA as a reliever
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15
Q

Maintainance and reliever therapy with other inhalers

A
  • Total dose of ICS shouldnt be decreased
  • Patient Taking regular once a day
  • rescue doses of the combination inhaler
  • Seperate SABA eliever inhaler not required
  • Counselling required
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16
Q

Fostair MART

A
  • Beclametasone/Formoterol 100/6 (Meter dose inhaler)
  • > 18 licence
  • One puff twice a day additional puff if symptoms persist
  • Max 8 puffs in 24hrs
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17
Q

Symbicort SMART

A
  • Turbohaler with budesonide/formoterol 100/6 or 200/6
  • 12yrs and over
  • 100/6 take 2 puffs daily can increase to 200/6 strength two puff daily or two puff twice daily for some
  • Not >6 puff at once with max 8 puff in day
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18
Q

DuoResp Spiromax

A
  • Busonide/fomoterol 160/4.5 equal to 200/6 symbicort
  • > 18 yrs 2 puffs daily increase to 2 puff twice day for some
  • No more than 6 in one go and 8 in 24 hrs
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19
Q

Importance of inhaling slowly

A
  • Contains ICS possiblity of developing candisis due to hitting the back of throat
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20
Q

Short acting High risk selective B2-agonist

A
  • Inhaled short risk agonist used for immediate relief asthma symptoms
  • 3-5 duration
  • Salbutamol and terbutaline
21
Q

Long acting B2 agonist

A
  • Combination with ICS for prophylatic treatment
  • Duration of 12 hrs
  • Salmeterol and formoterol used for COPD
22
Q

Monitoring of Beta 2 agonist

A
  • Plasma potassium concentration in severe asthma
  • Blood glucose in diabetes
23
Q

MHRA advice on pMDI

A
  • Risk of airways obstruction from aspiration of loose objects
24
Q

CHM advice on LABA’s

Long acting bronchodialating inhaler

A
  • Added if regular use of ICS has failed to work
  • Not been initiated in patients with rapidly deteriorating asthma
  • Low dose and discontinued in absence of benefit
25
Q

Caution with selective B2 agonist

A
  • Arrhythmias
  • Cardiovascular disease and prolonged QT interval
  • Risk of hyperglycemia in diabetes
  • Hypokalemia due to corticosteroids
26
Q

Inhaled corticosteroids

A
  • Reduce airways inflammation and redue oedema and secreation of mucus in airways
  • Beclametasone dipropinate
  • Budesonide
  • Mometasone furoate
27
Q

Monitoring of ICS

A
  • Weight and height of children reciving prolonged treatment annually
  • Slowed growth refer to peads
28
Q

MHRA info on ICS

A
  • pMDI risk of airway obstruction from aspiring loose objects
29
Q

MHRA advice on beclametasone inhalers

A
  • Not interchangeable must be prescribed by brand
  • Qvar twice as potent as clenil
30
Q

MHRA risk CSC

A
  • Rare risk of central serous chorioretinopathy as well as local systemic administeration
31
Q

Cautions of ICS

A
  • Systemic absorption may follow inhaled administeration
  • Candidiasis - risk reduction from using a spacer and rinse mouth with water after inhaling
  • Paradoxical bronchospasm - bronchodialator beforehand ICS should be discontinued
32
Q

Adult >17

ICS dose

A
  • 400mcg busonide dose would be low dose
  • 400-800mcg is moderate dose
  • > 800mch is a high dose
33
Q

Children <16

ICS dose

A
  • <200mcg concider low pead dose
  • 200-400mcg moderate pead dose
  • > 400mcg concider high dose
34
Q

Theophylline

A
  • Narrow theraputic drug 10-20 mg/L
  • Sampe should be taken every 4-6 hrs after oral dose
35
Q

Pharmacokenetics Theophylline

A
  • Dose adjustments may be necessary if soking started or stopped during treatment
  • Plasma conc decrease in smokers, alcohol consumption and enzyme inducer
  • Plasma conc increased cause heart failure, hepatic impairment and viral infection
36
Q

Overdose symptoms of Theophylline

A
  • Due to narrow theraputic index
  • Severe vomiting
  • Agitation
  • Restlessness
  • Dialated pupils and sinus tachycardia
  • Hyperglycemia and convulsions
  • Severe hypokalemia
37
Q

Cautions with Theophylline

A
  • Cardiac arrhithmyas and cardiac disease
  • Elderly
  • Epilepsy
  • Hypertention
  • Peptic ulcer
38
Q

Leukotrine receptor antangonist

A
  • Monotekulast
  • MHRA advice risk of neuropsychatric reaction
  • Eosinophilic granulomatosis with polyangiitis - Look out for eosinophilic rash worsening pulmonary systems and cardiac
  • Avoid pregrancy unless essential
39
Q

COPD treatment guideline

A
  • Look at spirometrically confirmed diagnosis
  • Assess air flow limitation
  • Assess symptoms risk and exacebation
    • <70 then issue
  • Post brochodialator FEV1/FVC gold 1 >80 and <40 is gold 4 for improve
40
Q

Dypeanea

A
  • LABA/LAMA or LABA +ICS
  • LABA+LAMA OR LABA+ICS+LAMA
  • Consider switch of inhaler if not working
41
Q

Exacerbations

A
  • LABA/LAMA or LABA +ICS
  • LABA+LAMA concider if eos >100
  • LABA+ICS+LAMA
  • If eos is <100 then roflumilast FEV <50% chronic brochitis
  • Azithomycin if former smoker

eos - eoseniphil blood count

42
Q

LAMA examples

A

Tiotropium
Umeclidinium Glycopyronnium

43
Q

MHRA Inhaled antimuscarinics

A
  • Inhalation of capsule if placed in the mouthpiece of the inhaler
  • bladder outflow obstruction
  • Constipation and arrhythmias
44
Q

Management of exacerbation

A
  • Short acting require higher dosage
  • Increase in dyspnea, increased sputum volume
  • Hydrocortisone for life threatening asthma
  • Predisolone used as a short course
  • Antibiotics when there is a sign of infection
45
Q

According to gold standard what would give patient in group A

A
  • A SABA (Salbutamol) inhaler or a SAMA (e.g. ipratropimum) inhaler as inly 0-1 exacerbation
  • mMRC 0-1 CAT score <10
46
Q

According to gold standard what would give patient in group B

A
  • LABA Famoterol or samoterol or LAMA (Tiatropium) - long lasting BA or MA
  • Moderate exacebation 0-1
  • mMRC >2 CAT score >10
47
Q

According to gold standard what would give patient in group C

A
  • LAMA (Tiatropium) - long lasting MA
  • > 2 Moderate exacebation OR >1 hospitalization
  • mMRC 0-1 CAT score <10
48
Q

According to gold standard what would give patient in group D

A
  • LAMA or LABA + LAMA or ICS + LABA
  • Asthma regualtion due to receptors
  • ICS used due to high esinophil levels if COPD patient
  • Do not need ICS using may cause pneumonia

PMP 201 Patient-Centred Learning (51 decks)

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