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Respiratory System > Management of asthma adults and children > Flashcards

Management of asthma adults and children Flashcards

1
Q

What are symptoms of asthma?

A
  • Shortness of breath
  • Wheeze
  • Cough
  • Chest tightness
  • Diurnal variability
  • Episodic
  • Atopy
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2
Q

What are signs of asthma?

A
  • Wheeze on auscultation
  • Eczema
  • Obstructed spirometry
  • Peak expiratory flow (PEF) changes
  • Response to treatment
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3
Q

What are the aims of treatment of asthma?

A
  • No daytime symtoms
  • No need for rescue medication
  • No asthma attacks
  • Minimal side effects from medication
  • No limitations on activity including exercise & normal lung function (in practical terms FEV1 and/or PEF>80% predicted or best)
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4
Q

What are non pharmacological management methods of asthma?

A
  • Exercise
  • Smoking cessation
  • Weight management
  • Flu/pneumococcal vaccinations
  • Patient education and self management plans
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5
Q

Pharmacological managements of asthma

A
  • Inhaled therapy
  • Oral therapy
  • Specialist treatments
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6
Q

How do you evaulate and assess someone with asthma?

A
  • Assess symptoms
  • Measure lung function
  • Check inhaler technique and adherence
  • Adjust dose
  • Update self-management plans
  • Move up and down plan as appropriate
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7
Q

What are 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

Types of inhalers

A
  • pMDI (metered dose inhalers)
  • pMDI with spacers
  • Dry powder inhalers (DPI)
  • Short acting B2 agonists (SABA)-relievers
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9
Q

Types of Short acting B2 agonists (SABA)

A
  • Salbutamol: MDI, DPI

- Terbutaline: DPI

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10
Q

Examples of oral therapy for asthma

A
  • Leukotriene receptor antagonist
  • Theophylline
  • Prednisolone
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11
Q

Specialist options for treatment of asthma

A
  • Omalizumab (Anti- IgE)
  • Mepolizumab (anti-interleukin-5)
  • Bronchial thermoplasty
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12
Q

What to do for a mild acute asthma attack?

A
  • Increase inhaler use
  • Oral steroid
  • Treat trigger
  • Early follow up
  • Back up plan
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13
Q

What to do for a moderate-severe acute asthma attack?

A
  • Nebulisers: salbutamol/Ipatropium
  • Oral/IV steroid
  • Magnesium
  • Aminophylline
  • Triggers: infection/allergen
  • Complications: CXR
  • Review
  • Level 2/3 care
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14
Q

Contrasts of asthma with COPD

A
  • Age of onset
  • Smoking history
  • Response to treatment
  • Treatment goals
  • Trajectory
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15
Q

Similarities of asthma with COPD

A
  • Similar therapies

- Non-pharmacological interventions same

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16
Q

How to measure control of asthma in children?

A
  • Closed questions
  • SANE:
  • Short acting beta agonist/week
  • Absence school/nursery
  • Nocturnal symptoms/week
  • Excertional symptoms/week
17
Q

What is the step up step down approach?

A 
Start on low dose ICS
- Severe may respond to minimal treatment
Review after 2 months
- No routine test to monitor progress
- Stepping up easier than down
18
Q

What are the different classes of medications for asthma?

A
  • Short acting beta agonists
  • Inhaled corticosteroids (ICS)
  • Long acting beta agonists*
  • Leukotriene receptor antagonists*
  • Theophyllines*
  • Oral steroids#
  • = add ons
19
Q

What is the contrast of children’s asthma treatment compared to adults?

A
  • Max dose ICS 800 microg (<12 yo)
  • no oral B2 tablet
  • LTRA first line preventer in <5s
  • No LAMAs
  • Only two biologicals
20
Q

How should you use long acting beta agonist?

A
  • Do not use without inhaled corticosteroids

- Use as fixed dose inhaler

21
Q

Features of leukotriene receptor antagonist

A
  • Montelukast only
  • Rule of thirds
  • Better adherence
  • Granules for reluctant toddlers
22
Q

High dose therapies for under 5s and over 5s

A
  • Under 5s, refer for confirmation of diagnosis

- Over 5s, increase to medium dose ICS and consider referral

23
Q

What are the 2 types of delivery systems for children?

A
  • MDI/spacer

- Dry powder device: under 8s cannot use them

24
Q

MDI spacer compared to nebuliser

A
  • Quieter
  • Quicker
  • Valve mechanism
  • Don’t break down
  • Portable
  • Cheaper
25
Q

Confirmed other management methods to improve asthma

A
  • Stop tobacco smoke exposure

- Remove environmental triggers: Cat, Dog

26
Q

What do you use to treat mild acute asthma in children?

A
  • SABA via spacer

- SABA via spacer + pred

27
Q

What do you use to treat moderate acute asthma in children?

A
  • SABA via neb + pred

- SABA + ipra via neb + pred

28
Q

What do you use to treat serious acute asthma in children?

A
  • IV salbutamol
  • IV aminophylline
  • IV magnesium (neb)
  • IV hydrocortisone
  • Intubate and ventilate
29
Q

How do you choose what treatment to use for acute asthma in children?

A

Look at the patient

  • Respiratory rate
  • Work of breathing
  • Heart rate
  • Oxygen saturations
  • Ability to complete sentences
  • Confusion
  • Air entry
30
Q

In what treatments do you use inhaled steroids and oral steroids?

A
  • Chronic/maintenance treatment = inhaled steroids (not oral steroids)
  • Acute treatment = oral steroids (not inhaled steroids)
31
Q

Quote to remember

A

No wheeze, No asthma

Respiratory System (28 decks)

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