Management of Asthma in Adults

Question 1

Non Pharmacological management of asthma includes:

Answer 1

Exercise, Stopping smoking, weight managemtne, patient education and self management plans, flu/pneumococcal vaccinations

Question 2

What is a pMDI?

Answer 2

Metered Dose Inhalers

Question 3

What are the advantages of using inhalers?

Answer 3

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

Question 4

What in an advantage/disadvantages of using a DPI over a pMDI?

Answer 4

No coordination required (don’t have to press cannister and breathe at the same time), so good for patients who struggle with dexterity.

Disadvantages, need a minimum a mount of inspiratory flow for inhaler to work (whereas can use spacer with pMDI and just take tidal breaths.

Question 5

What is a DPI?

Answer 5

Dry Powder Inhaler

Question 6

What are SABAs and give examples

Answer 6

Short Acting B2 Agonists - Relievers (symptom control)

Salbutamol
MDI
DPI

Terbutaline (if don’t tollerate Salbutamol eg. causes tremor/increased heart rate)
DPI

Question 7

How is Salbutamol administered and what is it used as?

Answer 7

Via MDI or DPI, as a SABA - reliever

Question 8

How is Terbutaline administered and what is it?

Answer 8

A SABA B2 agonist - reliever.

DPI

Question 9

Where are B2 receptors found and when activated what do thy cause?
Are they part of the spympathetic or parasympathetic system?

Answer 9

Part of sympathetic (fight or flight )
Bronhio smooth muscle in lungs and airways - bronchodilation
Vascular smooth muscle on eart and skeletal muscles - vasodilation
Pancreas - increase in insulin production
Decrease in GI motility (relaxation of smooth muscle)
Inhibition of labour (relaxation of smooth muscle)

Question 10

Give 3 examples of oral therapy drugs and when they might be used)

Answer 10

Leukotriene Receptor Antagonist - patients with a significant allergic response to their asthma)

Theophylline - difficult to control asthme

Prednisolone - acute exacerbations

Question 11

What is Omalizumab?

Answer 11

Anti IgE, administered IV, specialist option (green)

Question 12

What is Mepolizumab?

Answer 12

A specialist option (yellow) - Anti-Interleukin-5

Question 13

What is Bronchia; Thermoplasty?

Answer 13

VERY specialised treatment, patients who have failed all other theapies

Question 14

What is acute asthma

Answer 14

Not day to day symptoms but exacerbation of symptoms (building up to an attack)

Question 15

What do you do as a result of a mild/moderate asthma attack

Answer 15

O T(h)INK
Oral Steroid
Treat trigger
Increase inhaler use
Near (early) follow up (first 12-24 hours)
bacK up plan

Increase inhaler use
Oral Steroid
Treat trigger
Early follow up
Back up plan

Question 16

Where should you end up in a moderate/severe asthma attack? What could they give you/what would they look at doing?

Answer 16

Hospital:
Nebulisers – Salbutamol/Ipratropium
Oral/IV Steroid (eg IV hydrocortisone - shorter acting than tablet)
IV Magnesium - patients don’t typically like - makes them feel as though they’re going to wet themselves
Aminophylline GET THE SPECIALIST
Triggers – infection/allergen (history)
Complications – CXR eg pneumothorax
Review
Level 2/3 care - level 1 = ward based, level 2= high dependancy care (single organ support), level 3 care= intensive care - multiorgan support is offered

Question 17

What is the current first step for a clinician who has a suspicion of asthma?

Answer 17

Give them an inhaled corticosteroids (ICS) as they are far more efficient in managing asthma

Question 18

What is airflow obstruction defined as?

Answer 18

fev1/fvc > 70

Question 19

wHAT ARE THE INDICATIONS OF COMMENCING ics?

Answer 19

Using SABA3+ times a week
Symptomaic 3+ times a week
Waking one night/week
ASthma attack in the last 2 years

Question 20

What arethe 3 monitoring quetsions ti check with asthma patients?

Answer 20

• Difficulty sleeping due to asthma
• Had asthma symptoms in the day
• Asthma iterferred with usual activities

Question 21

Do you have complete control if you are using salbutamol inhaler 2x/week?

Answer 21

No