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BNF Respiratory > Obstructive airway disease > Flashcards

Obstructive airway disease Flashcards

1
Q

what is a common chronic inflammatory condition of the airways associated with airway hyperesponsiveness and variable airflow obstruction

A

Asthma

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2
Q

Symptoms of asthma

A

cough, wheeze, chest tightness, breathlesness

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3
Q

What is the name of the syndrom that has both asthma and COPD features?

A

Asthma-copd overlap syndrome (ACOS)

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4
Q

What is defined as complete control of asthma?

A

No daytime symptoms, no night time wakening, no asthma attacks, no need for rescue medication, no limitations during exercise, FEV1 of >80%

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5
Q

What lifestyle changes can help with asthma symptoms?

A
  1. weight loss
  2. smoking cessation
  3. breathing exercise programmes
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6
Q

Before initiating a new asthma drug what should be checked?

A

Inhaler technique, adherence, eliminate triggers

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7
Q

FEV1

A

the amount of air a person can forcefully exhale in one second

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8
Q

FVC

A

the total amount of air exhaled in one breath

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9
Q

First line medication for Asthma in patients age 17 and over

A

SABA ( salbutamol, terbutaline)

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10
Q

How frequently must a patient be using their SABA before they need urgent assessment?

A

If going through >1 inhaler a month

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11
Q

What features warant starting ICS therapy?

A
  1. using a SABA three times a week
  2. symptomatic three times a week
  3. waking a night due to asthma symptoms at least weekly
  4. Had an asthma attack in the last 2 years
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12
Q

At what frequency do SIGN/BTS suggest ICS should be administered initially?

A

BD

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13
Q

True or false - BTS/SIGN recommend prescribing inhalers by brand?

A

True

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14
Q

If asthma is uncontrolled on ICS + SABA what is the initial add on therapy?

A

Leukotriene receptor antagonist e.g. Montelukast and review responce in 4 - 8 weeks

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15
Q

what is third line asthma therapy for NICE guidelines?

A

ICS + LABA (with or without LRTA)

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16
Q

Whast is the forth line for asthma therapy according to NICE?

A

MART

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17
Q

What is MART ?

A

Maintenance and reliever therapy - one combination inhaler

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18
Q

Examples of MART inhalers?

A

Symbicort
Fostair
DuoResp Spiromax
Fobumix Easyhaler

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19
Q

If MART does not work, what are the other options?

A
  1. Increase ICS + LABA + LRTA or increase ICS and continue MART
  2. High ICS / theophylline / LAMA –> refer
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20
Q

Examples of monoclonal antibodies that can be used for asthma?

A

Omalizumab, mepolizumab. benralizumab, reslizumab

21
Q

How long should you trial ICS in a child <5 years if they have symptoms to suggest its use?

22
Q

When should you consider reducing the maintenance dose of asthma treatment?

A

When symptoms are well controlled for at least 3 months

23
Q

What dose of ICS should patient’s be maintained on?

A

The lowest possible dose

24
Q

What is the drug of choice for exercised induced asthma?

25
Q

What marks an acute asthma exacerbation?

A

reduction in baseline measures of pulmonary function e.g. FEV1 and peak flow

26
Q

What are the features of moderate acute asthma?

A

Peak flow >50-75% best or predicted, no features of acute severe asthma

27
Q

what are the features of severe acute asthma?

A

Peak flow 33-50% best or predicted, RR >25, HR>110, inability to speak sentences in one breath

28
Q

What are the features of life threatening acute asthma?

A

Peak flow <33% best or predicted, SpO2 <92%, PaO2<8kPa, normal PaCo2, cyanosis, silent chest, arrhythmia, exhaustion, hypotension

29
Q

What is a feauture of near-fatal acute asthma?

A

Raised PCo2 and/or the need for mechanical ventiliation with raised inflation pressures

30
Q

What types of asthma need to be admitted to hospital?

A

Severe or life threatening cases

31
Q

What is the O2 sat aim for an asthma patient?

32
Q

Treatment for acute asthma exacerbation

A
  1. High dose LABA ( potentially nebulised or given IV if cannot have inhaled therapy)
  2. Prednisolone 40mg PO 5 days minimum (or IV methylpred/hydrocortisone)
  3. Magnesium sulfate 1.2 -2g infusion / Aminophylline infusion ( unlikely)
  4. Ipatropium nebs in severe/life threatening asthma
33
Q

Examples of SABA

A

Salbutamol, terbutaline

34
Q

Example of an antimuscarinic used in asthma

A

Ipratropium

35
Q

When should blood levels for Aminphylline be taken?

A

4 -6 hours post oral dose or when starting/changing infusion

36
Q

Target level for aminophylline

37
Q

ADR associated wiht SAlbutamol and terbutaline

A

Fine tremor (esp hands), headache, tachycardia

38
Q

ADRS associated wiht ICS

A

Oral candidiasis, headache, altered taste and voice

39
Q

How quickly dose SABAs act and wean off?

A

act within 3-5 minutes, effecg wears off within 4 - 6 hours

40
Q

Sied effects of LTRA

A

diarrhoea, vomiting, fever, nausea, abdominal pain

41
Q

Side effects of LAMA

A

acute close angle glaucoma, dry mouth, constipation

42
Q

Examples of methylxanthines

A

Aminophylline, theophylline

43
Q

Low potency ICS example

A

Budesonide 400mcg BD

44
Q

Moderate dose ICS example

A

Budesonide 400-800mcg BD

45
Q

High dose ICS example

A

> 800mcg BD budesonide

46
Q

When should LTRA be taken?

A

in the evening

47
Q

Example of LABAs

A

Salmeterol annd Fometerol

48
Q

What drug is in spiriva respimat?

A

Tiotropium (LAMA)

49
Q

What asthma medication should be prescribed as brand specifically?

A

Theophylline

BNF Respiratory (6 decks)

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