Practical Aspects of Asthma Management Flashcards

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1
Q

4 signs of variable airway obstruction

A

Frequent episode of breathlessness
Chest tightness
Wheezing
Cough

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2
Q

3 things needed to confirm asthma

A

Reversible airway obstruction (spirometry)
Variable airflow limitation over time (PEF monitoring)
Airway hyper-responsiveness (bronchoprovocation testing)

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3
Q

What % change do you need after giving a bronchodialator to diagnose asthma?

A

> 12%

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4
Q

Peak expiratory flow monitoring

A

Brief forceful exhalation
Can do this multiple times a day and can do it at home
Can create an action plan based on the volume to monitor lung function

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5
Q

2 ways to do bronchoprovocation testing

A

Methacholine challenge test

Exercise challenge test

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6
Q

Methacholine challenge test

A

Derivative of ACh
Causes bronchoconstriction
Series of methacholine solutions are administered progressively via nebulizer
Measure FEV1
16 mg/mL and above is normal, below 4 is asthmatic

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7
Q

Goals of asthma management

A

Achieve good symptom control
Minimize future risk of exacerbation
Minimize future risk of fixed airflow limitation
Minimize side effects from treatment

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8
Q

Order of asthma management continuum

A
Confirm diagnosis
Environmental control, education, written action plan
Fast-acting bronchodilator on demand
Inhaled corticosteroid
Add LABA
Add LTRA
Prednisone
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9
Q

Comorbidities that can worsen asthma control

A
Chronic rhinosinusitis
GERD
OSA
Obesity
Allergic bronchopulmonary aspergillosis
Vocal cord dysfunction
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10
Q

Reliever therapy

A

For all patients with asthma
Fast acting beta2 agonists
Used PRN
Frequency of use can be used to monitor asthma control (give controller when using it 4 or more times a week during the day)
Side effects: tachycardia, nervousness, tremour

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11
Q

Controller therapy

A

Inhaled corticosteroid
Cornerstone of asthma maintenance
Results in: decreased symptoms, increased QoL, increased lung function, decreased hyper responsiveness, decreased airway inflammation, decreased frequency/exacerbations, decreased mortality

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12
Q

What are some
1. Local
2. Systemic
Adverse effects of inhaled ICS

A
  1. Oropharyngeal candidiasis, dysphonia, cough

2. Easy bruising, decreased bone density, cataracts

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13
Q

What is a problem with LABAs?

A

CANNOT give them as monotherapy
They have insufficient anti-inflammatory properties and increase the risk of death and hospitalization
Create long acting bronchodilation but doesnt treat the cause - so you dont notice the symptoms but then when you get really bad you cant expand any further

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14
Q

LTRAs

A

Leukotriene receptor antagonists
Anti inflammatory drugs interfering with leukotriene receptors
Second line therapy (asthma patient with allergic rhinitis)

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15
Q

Tiotropium

A

Long acting anticholinergic
Reduces risk of exacerbations and improves lung function in patients with uncontrolled asthma despite ICS/LABA
Adverse effect: dry mouth

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16
Q

Prednisone

A

Treatment of exacerbations

Chronic management of refractory asthma