Management of Asthma in adults Flashcards
What are the guidelines for management of asthma?
SIGN guidelines
GINA guideline
Non pharmacological treatment of asthma?
Exercise
smoking cessation
weight management
Describe the asthma plan?
my asthma triggers
my asthma review
what to take and when
Steps for asthma treatment?
clinical suspicion of asthma - first give inhaled corticosteroid
then if getting little better- increased dose and adding other things such as long acting beta agonists (relax smooth muscle around airway) and stuff that relieves inflammation
adding oral therapies and highly specialized therapies
chest clinic
positives of use of inhalers?
small dose drugs
delivery directly to the target organ (airway and lung)
onset of effect is faster
minimal systemic exposure
systemic adverse effects are less severe and less frequent
Describe pMDI (metered dose inhalers)?
can is pressurized
-relies on coordinating breath with pressing on cannister
pMDI with spacers recommended- drug is accumulated in chamber and then patient performs normal breathing and gets maximum delivery of drug
Describe dry powder inhalers?
open device and then just suck
- do have to have a minimum inspiratory flow
Describe short acting beta 2 agonists (SABA)?
what you give to patients for symptom control
- not treatment of underlying asthma
salbutamol common - side effects of tremor and increased HR
terbutaliine
What are the oral therapies?
leukotriene receptor antagonist or montelucaste- allergic response to asthma
theophylline
prednisolone - use in acute exacerbations
What are the specialist options for asthma treatment?
these target pathological processes
Omalizumab (Anti IgE)
mepolizumab (anti-interleukin-5)
bronchial thermoplasty
moderate asthma?
increasing symptoms
PEF >50-75%
no features of acute severe asthma
Acute severe asthma?
PEF 33%-50% best or predicted
resp rate >25/ min
heart rate >110/ min
inability to complete sentences in one breath
Life threatening asthma?
altered conscious level
exhaustion
arrythmia
hypotension
cyanosis
silent chest
poor resp effort
PEF<33%
SpO2< 92%
PaO2<8 kPa
normal PaCO2 (4.6-6.0 kPa)
Near fatal asthma?
raised partial pressure of carbon dioxide and requiring mechanical intervention with raised inflation pressures
for mild / moderate acute asthma attack?
increase inhaler use
oral steroid
treat trigger
early follow up
back up plan
for a moderate/ severe asthma attack?
- nebulisers- salbutamol / ipratropium
-oral / iv steroid (short acting though)
-IV magnesium ( bad side effects)
-IV aminophylline
Triggers- infection/ allergen
complications- CXR- possible pneumothorax
review
level 2/3
Level 1, 2 ,3 meanings?
level 1 -ward based
2- high dependency care (single organ suppport)
3- multi organ support
Difference of how we manage asthma and COPD?
treatment goals
age of onset
smoking history- COPD
reversibility- for COPD
similar therapies
