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1st year systems ADAM > Management of Asthma- Adults > Flashcards

Management of Asthma- Adults Flashcards

1
Q

What cells are responsible for the effects of asthma?

A

Th2 Cytokines - (IL-5, LT)

Eosinophils

Mast cells

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2
Q

What is the difference between occupational asthma and work-exacerbated asthma?

A

Occupational has no prior history of asthma

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3
Q

What is non-pharma management of chronic asthma?

A

Asthma Action Plan

Weight loss if ˄BMI

Vaccines – flu & pneum

Allergen avoidance

(inc. occup. Asthma)

Physiotherapy

Smoking Cessation

Bronchial Thermoplasty

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4
Q

What are the drugs used to treat acute asthma attack and chronic asthma?

A
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5
Q

What are the drugs to avoid during the treatment of asthma?

A

β-blockers

NSAIDS / Aspirin

Sedatives/strong opiates (unless in critical care)

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6
Q

What are the non-pharma methods of treatment of acute asthma attack?

A

ITU/HDU

Ventilation

ECCO2R

Chest drain if

pneumothorax

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7
Q

What are the benefits of inhalers?

A
  • Small dose of drugs
  • Delivery directly to the target organ (airways and lung)
  • Onset of effect is faster
  • Minimal systemic exposure
  • Systemic adverse effects are less severe and less frequent
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8
Q

What are the problems associated with metered dose inhalers?

A
  • Needs co-ordination
  • Elderly, young children, unwell can’t use effectively
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9
Q

What are the benefits of spacers?

A
  • Low oro-pharyngeal deposition of aerosol
  • Reduced speed of the aerosol
  • decreases bad taste associated with oral deposition
  • reduced the risk of oral candidiasis and dysphonia with steroids
  • Reduced “cold-Freon effect” in some
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10
Q

What are the benefits associated with dry powder inhalers?

A
  • Less coordination required
  • Similar issues with deposition

Requires high inspiratory flow

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11
Q

What does SABA stand for?

A

Short acting beta 2 agonists

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12
Q

Where do you find salbutamol?

A

MDI

DPI

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13
Q

Where do you find terbutaline?

A

DPI

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14
Q

What are the adverse side effects of beta 2 stimulants?

A
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15
Q

What are regular preventers?

A

Low dose Inhaled Corticosteroids (ICS) - Preventers

  • Beclomethasone
  • Budesonide
  • Fluticasone
  • Ciclesonide
  • Mometasone
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16
Q

When do you start ICS?

A
  • Using inhaled β2 agonist (“Reliever”) x3/week or more
  • Waking one night a week or more due to asthma
  • Requiring oral steroid for an exacerbation in the past 2 years
  • Symptomatic x3/week or more
17
Q

What are the advantages of inhaled ICS?

A
18
Q

What are the side effects of Long term oral cortical steroid use?

A
19
Q

What are the long term side effects of inhaled long term steroids?

A

Dysphonia - difficulty in speaking due to a physical disorder of the mouth, tongue, throat, or vocal cords.

•Oropharyngeal Candidiasis

20
Q

When do you move up the steps from SABA to ICS?

A

If it is being used three times a week

21
Q

WHat is the first stage of management after Asthma diagnosed

A

Regular preventer

Add inhaled low-dose ICS

22
Q

What is the 2nd stage of treating asthma

A

Initial add-on therapy

Add inhaled LABA to low dose ICS

23
Q

Additional add on therapy

What should you do if there is no response to LABA?

A

Stop using it and consider an increased dose of ICS

24
Q

Additional add on therapy

What should you do if there is a benefit from LABA but control is still inadequate?

A

Continue LABA and increase ICS to medium dose

Or Continue LABA and ICS and consider LRTA, SR theophylline, LAMA

25
Q

What are the possible high dose therapies?

A

Increasing the ICS up to high dose

Addition of a fourth drug - LRTA, SR theophyline, beta agonist tablet, LAMA

26
Q

What is the very last stage of asthma treatment?

A

Daily steroid tablets

Maintain high dose ICS

Consider other treatments to minimise the use of steroids

27
Q

Give examples of Leukotrine receptor antagonists

A

Montelukast

•Zafirlukast

28
Q

What is theophylline?

A

Phosphodiesterase inhibitor

Adenosine receptor antagonist

Weak bronchodilator

29
Q

What are the downsides to using Theophylline?

A

Many side effects

Narrow therapeutic window

Unpredictable metabolism - interacts with many drugs

30
Q

Give an example of a long term oral steroid

A

Prednisolone

31
Q

What dose is recommended for long term oral steroids?

A

Lowest oral dose that controls symptoms

32
Q

What is the cytokine that is responsible for driving the hypersensitivity in asthma?

A

Interleukin - 5

33
Q

What are the non-pharmacological methods of asthma management?

A

Patient education and self-management plans

Inhaler technique

Smoking cessation

Vaccinations (flu/pneumococcal)

Allergen avoidance - removal needed if occupational asthma

Bronchial thermoplasty - heating parts of the airway with a heater probe

34
Q

Acute asthma

What is defined as moderate asthma?

A
35
Q

What is defined as acute severe asthma?

A
36
Q

Acute asthma

What is defined as life-threatening asthma?

A
37
Q

What is defined as near fatal asthma?

A

Raised PaCO2 and/or requiring mechanical ventilation with raised inflation pressures (504-507)

38
Q

What is the treatment of acute asthma - mild/moderate?

A
39
Q

What is treatment for acute asthma - severe?

A

Ipratropium is a short acting muscarinic drug

Nebulisers- salbutamol/Ipratropium

Oral/IV steroid

MASH

Level ⅔ care

1st year systems ADAM (52 decks)

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