Management of asthma in adults Flashcards
why is asthma therapy important
common
manageable
dangerous
expensive
pharmacological management of asthma
inhaled therapy
oral therapy
specialist treatments
inhalers
Small dose of drugs
Delivery directly to the target organ (airways and lung)
Onset of effect is faster
Minimal systemic exposure - bypass first pass metabolism
Systemic adverse effects are less severe and less frequent
types of inhlaers (4)
Pressurised Metered Dose Inhaler (pMDI)
pMDI with spacers
dry powder inhalers
short acting B2 agonists (SABA)
Oral therapy for asthma control (3)
Leukotriene Receptor Antagonist
Theophylline
Prednisolone
specialist asthma treatment options
omalizumab
mepolizumab
bronchial thermoplasty
severity of asthma stages
moderate
acute severe
life-threatening
near-fatal
what prevents death in acute cases
urgent intervention
important part of asthma control?
asthma action plan- unique to patient
if there is a low probability from clinical investigation that an adult has asthma what should be done?
investigate or treat other cause
consider referral
if no response to treatment, consider further investigation or onward referral
if there is an intermediate probability from clinical investigation that an adult has asthma what should be done?
if their FEV1/FVC ratio is:-
more than 0.7 or 80% then move to low probability and consider referral or treat other cause
less than 0.7 or 80% then move to high probability and trial asthma treatment
if there is a high probability from clinical investigation that an adult has asthma what should be done?
trial of asthma treatment
if successful, continue minimum effective dose. If unsuccessful, assess inhaler technique/compliance
if no further improvement consider onward referral
difference between spirometry and peak flow?
peak flow cannot be used to diagnose asthma
just shows max speed person can get air out
spirometry can be used to diagnose asthma so is first option for testing in clinical investigation
lifestyle management for chronic asthma
smoking cessation
weight loss if overweight
avoid things that exacerbate it- soft furnishings, pets etc
teach how to use peak flow to monitor PEF 2x a day
specific advice on what to do in emergency/ acute attack
how many times a day should peak flow be measured?
2 x a day
Treatment guidelines for asthma in adults
Start with inhaled corticosteroid and inhaled beta 2 agonist if >17 (new BTS/SIGN 2016 and NICE 2017 asthma guidelines are moving away from beta agonist monotherapy unless people have very infrequent symptoms)
If no effect then stop LABA and just have the increased dose of ICS on it’s own.
- consider trials of:- increased ICS again. Or an oral steroid (ie. Leukotriene Receptor Antagonist, Theophylline or Prednisolone) with previous therapy
- add a refular oral steroid - 1 dose daily, lowest possible dose. Continue with high does ICS. Refer for specialist input.
give names of 2 short acting beta 2 agonists
salbutamol
terbutaline
give the name of 1 long acting beta 2 agonist
salmeterol
how is salbutamol given
best inhaled - aerosol, powder, nebuliser
but also given IV or orally
why are corticosteroids inhaled and how do they work`
to reduce systemic effects
they work over days to reduce bronchial mucosal inflammation
can be used acutely (high dose, short course) and long term (low dose)
difference between PEF and FEV1 ie peak flow and spirometry
PEF gives highest speed of airflow, but does not determine presence of disease or severity. So how FAST you can get air out
FEV1 is used to diagnose ASTHMA or COPD as it shows the extent of obstruction. How MUCH air you can get out
what is peak expiratory flow?
Peak expiratory flow is a simple measure of airflow obstruction that can be done by the patient themselves
usually, peak flow values will drop before symptoms of wheezing and coughing occur, making a peak flow meter a valuable adjunct to asthma management
Used correctly and regularly, peak flow meters can:-
provide early detection of worsening changes in lung function;
indicate one’s response to rescue treatment during an acute asthma episode
monitor the overall response to treatment
provide a pattern of data that can help determine whether one’s asthma is under “good control” or adjustments are needed in the management plan
evaluate the severity of asthma
Treatment for asthma patients >17 y/o (NICE)
SABA only used on its own if patient has very infrequent, short-lived wheeze and norm lung function
Offer a low dose of an ICS with a LABA as the first-line maintenance therapy
