Management of Asthma in Adults Flashcards
What is the aim of the treatment in asthma?
No daytime symptoms, no night time wakening, no need for rescue medication, no asthma attacks, no limitations on activity, minimal side effects from medications.
What are non-pharmacological ways to manage asthma?
Patient education and self management plans, exercise, smoking cessation, weight management, physiotherapy, vaccines, allergen avoidance, bronchial thermoplasty
What are inhalers?
Small dose of a drug, it allows it to be delivered directly to the target organs. The onset is very quick and there are very little systemic side effects.
What are the two main types of inahlers?
Metered dose inhalers (with spacers)
Dry powder inhalers
What are short acting beta agonist relievers examples?
Salbutamol - MDI, DPI
Terabutaline - DPI
What are the main symptoms of using salbutamol?
Tremor and increased heart rate.
What are the main examples of oral therapy?
Leukotriene receptor antagonist
Theophylline
Prednisolone
What are specialist options of treatment for asthma?
Omalizumab (Anti-IgE)
Mepolizumab (Anti-interleukin)
Bronchial thermoplasty
Only prescribed by specialists in the respiratory clinic
What is an acute asthma attack?
There is an increase in inhaler use, they may be given an oral steroid, you need to treat the trigger, you need to make sure that there is an early follow up, and you need to have a back up plan just in case.
What should you do with a severe asthma attack?
The patient should be in hospital.
They are now using nebulisers, Oral or IV steroids (faster onset), IV magnesium (doesnt make patients feel great), IV amophylline, trying to treat the triggers,
Complication (people who breath hard and hyperventilate are at a risk of getting pneumothorax.)
Level 2/3 care
What is the contrast between COPD and asthma?
Both have airways inflammation and irritability of the smooth muscle causing increased contraction and narrowing of the airways.
Aim of treatment is reducing the number of exacerbations they have.
Patients of asthma tend to be younger whereas some patients with COPD are smokers and they tend to be in the 50s and over.
However non pharmacological interventions tend to be the same
What cells are responsible for the effects of asthma?
Th2 Cytokines, Eosonophils, mast cells
What is the major contributor of the air resistance of a tube?
The radius
What is the difference between occupational asthma and work exacerbated asthma?
Occupational has no prior history of asthma.
What are the drugs used to treat acute asthma attack and chronic asthma?
B2 agonist, steroids, anti-muscarinic, Theophyllines, Magnesium, Oxygen, Leukotriene RAs, Monoclonal Abs.
What are the drugs to avoid during the treatment of asthma?
NSAIDS/Aspirin, Sedatives/strong opiates (unless in critical care)
- What are the non-pharma methods of treatment of acute asthma attack?
ITU/HDU, Ventilation, ECCO2R, Chest drain if pneumothorax
- What are the benefits of 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 are the problems associated with metered dose inhalers?
Needs co-ordination, Elderly, young children, unwell can’t use effectively
What are the benefits of spacers?
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