Practical Aspects of Asthma Management Flashcards
4 signs of variable airway obstruction
Frequent episode of breathlessness
Chest tightness
Wheezing
Cough
3 things needed to confirm asthma
Reversible airway obstruction (spirometry)
Variable airflow limitation over time (PEF monitoring)
Airway hyper-responsiveness (bronchoprovocation testing)
What % change do you need after giving a bronchodialator to diagnose asthma?
> 12%
Peak expiratory flow monitoring
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
2 ways to do bronchoprovocation testing
Methacholine challenge test
Exercise challenge test
Methacholine challenge test
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
Goals of asthma management
Achieve good symptom control
Minimize future risk of exacerbation
Minimize future risk of fixed airflow limitation
Minimize side effects from treatment
Order of asthma management continuum
Confirm diagnosis Environmental control, education, written action plan Fast-acting bronchodilator on demand Inhaled corticosteroid Add LABA Add LTRA Prednisone
Comorbidities that can worsen asthma control
Chronic rhinosinusitis GERD OSA Obesity Allergic bronchopulmonary aspergillosis Vocal cord dysfunction
Reliever therapy
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
Controller therapy
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
What are some
1. Local
2. Systemic
Adverse effects of inhaled ICS
- Oropharyngeal candidiasis, dysphonia, cough
2. Easy bruising, decreased bone density, cataracts
What is a problem with LABAs?
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
LTRAs
Leukotriene receptor antagonists
Anti inflammatory drugs interfering with leukotriene receptors
Second line therapy (asthma patient with allergic rhinitis)
Tiotropium
Long acting anticholinergic
Reduces risk of exacerbations and improves lung function in patients with uncontrolled asthma despite ICS/LABA
Adverse effect: dry mouth
