primary & secondary management of asthma Flashcards
what is asthma
- reversible airflow obstruction
- bronchial inflammation
- bronchial hyperresponsiveness
presenting symptoms
- breathlessness
- wheeze
- cough
diagnosis of asthma
presence of more than one symptom and variable airflow obstruction
tests for eosinophilic inflammation or atopy
- FeNO
- blood eosinophil
- skin-prick test, IgE
tests for variability
- reversibility
- PEF charting
- challenge tests
what would you start with for treating asthma
ICS - inhaled cortisteroid
2nd management
SABA + ICS + LABA/LAMA
- If no response - stop LABA and increase ICS
- If some response - continue LABA and increase ICS
3rd management
Add LTRA/Theo/Chromone
4th management
- Add oral steroid and anti-IgE/anti-IL5/anti-IL4⍺
- DO NOT USE oral steroid for long term!
- Only use MAX 1-2 weeks
exacerbations
A worsening of symptoms beyond normal day to day variation
I
ncrease ICS
Oral steroids 40mg OD for 5/7
Consider antimicrobials
who should be referred for asthma secondary care
- diagnosis unclear
- suspected occupational asthma
- poor response to asthma treatment
- severe/ life threatening asthma attack
red flags and indicators of other diagnosis
- prominent systemic features
- unexpected clinical findings (eg clubbing, crackles)
- persistent non-variable breathlessness
- chronic sutum production
- unexplained restrictive spirometry
- chest x-ray shadowing
- marked blood eosinophilia
what are alternative diagnosis’s for asthma
- dysfunctional breathing
- bronchiectasis
- severe chronic obstructive pulmonary disease
- vocal cord dysfunction
effects of smoking
Reduces ciliary beat frequency (sometimes to zero)
- Sputum retention
- Increased infections
Steroids are much less
effective in smokers
Macrolide antibiotics are not effective in smokers
eosinophilic asthma
- Usually adult onset
- Female preponderance
- More steroid resistant, usually
- Often stuck on prednisolone
- Anti-allergy therapy not effective
- Anti IL5 therapy
—–> Mepolizumab or Benralizumab
