Management of Asthma in Adults Flashcards
Non Pharmacological management of asthma includes:
Exercise, Stopping smoking, weight managemtne, patient education and self management plans, flu/pneumococcal vaccinations
What is a pMDI?
Metered Dose Inhalers
What are the advantages of using inhalers?
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
What in an advantage/disadvantages of using a DPI over a pMDI?
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.
What is a DPI?
Dry Powder Inhaler
What are SABAs and give examples
Short Acting B2 Agonists - Relievers (symptom control)
Salbutamol
MDI
DPI
Terbutaline (if don’t tollerate Salbutamol eg. causes tremor/increased heart rate)
DPI
How is Salbutamol administered and what is it used as?
Via MDI or DPI, as a SABA - reliever
How is Terbutaline administered and what is it?
A SABA B2 agonist - reliever.
DPI
Where are B2 receptors found and when activated what do thy cause?
Are they part of the spympathetic or parasympathetic system?
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)
Give 3 examples of oral therapy drugs and when they might be used)
Leukotriene Receptor Antagonist - patients with a significant allergic response to their asthma)
Theophylline - difficult to control asthme
Prednisolone - acute exacerbations
What is Omalizumab?
Anti IgE, administered IV, specialist option (green)
What is Mepolizumab?
A specialist option (yellow) - Anti-Interleukin-5
What is Bronchia; Thermoplasty?
VERY specialised treatment, patients who have failed all other theapies
What is acute asthma
Not day to day symptoms but exacerbation of symptoms (building up to an attack)
What do you do as a result of a mild/moderate asthma attack
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
Where should you end up in a moderate/severe asthma attack? What could they give you/what would they look at doing?
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
What is the current first step for a clinician who has a suspicion of asthma?
Give them an inhaled corticosteroids (ICS) as they are far more efficient in managing asthma
What is airflow obstruction defined as?
fev1/fvc > 70
wHAT ARE THE INDICATIONS OF COMMENCING ics?
Using SABA3+ times a week
Symptomaic 3+ times a week
Waking one night/week
ASthma attack in the last 2 years
What arethe 3 monitoring quetsions ti check with asthma patients?
- Difficulty sleeping due to asthma
- Had asthma symptoms in the day
- Asthma iterferred with usual activities
Do you have complete control if you are using salbutamol inhaler 2x/week?
No
