Management of asthma in adults

Question 1

why is asthma therapy important

Answer 1

common
manageable
dangerous
expensive

Question 2

pharmacological management of asthma

Answer 2

inhaled therapy
oral therapy
specialist treatments

Question 3

inhalers

Answer 3

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

Question 4

types of inhlaers (4)

Answer 4

Pressurised Metered Dose Inhaler (pMDI)
pMDI with spacers
dry powder inhalers
short acting B2 agonists (SABA)

Question 5

Oral therapy for asthma control (3)

Answer 5

Leukotriene Receptor Antagonist

Theophylline

Prednisolone

Question 6

specialist asthma treatment options

Answer 6

omalizumab
mepolizumab
bronchial thermoplasty

Question 7

severity of asthma stages

Answer 7

moderate
acute severe
life-threatening
near-fatal

Question 8

what prevents death in acute cases

Answer 8

urgent intervention

Question 9

important part of asthma control?

Answer 9

asthma action plan- unique to patient

Question 10

if there is a low probability from clinical investigation that an adult has asthma what should be done?

Answer 10

investigate or treat other cause

consider referral

if no response to treatment, consider further investigation or onward referral

Question 11

if there is an intermediate probability from clinical investigation that an adult has asthma what should be done?

Answer 11

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

Question 12

if there is a high probability from clinical investigation that an adult has asthma what should be done?

Answer 12

trial of asthma treatment

if successful, continue minimum effective dose. If unsuccessful, assess inhaler technique/compliance

if no further improvement consider onward referral

Question 13

difference between spirometry and peak flow?

Answer 13

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

Question 14

lifestyle management for chronic asthma

Answer 14

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

Question 15

how many times a day should peak flow be measured?

Answer 15

2 x a day

Question 16

Treatment guidelines for asthma in adults

Answer 16

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.

4. consider trials of:- increased ICS again. Or an oral steroid (ie. Leukotriene Receptor Antagonist, Theophylline or Prednisolone) with previous therapy
5. add a refular oral steroid - 1 dose daily, lowest possible dose. Continue with high does ICS. Refer for specialist input.

Question 17

give names of 2 short acting beta 2 agonists

Answer 17

salbutamol

terbutaline

Question 18

give the name of 1 long acting beta 2 agonist

Answer 18

salmeterol

Question 19

how is salbutamol given

Answer 19

best inhaled - aerosol, powder, nebuliser

but also given IV or orally

Question 20

why are corticosteroids inhaled and how do they work`

Answer 20

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)

Question 21

difference between PEF and FEV1 ie peak flow and spirometry

Answer 21

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

Question 22

what is peak expiratory flow?

Answer 22

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

Question 23

Treatment for asthma patients >17 y/o (NICE)

Answer 23

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