Resp 7.2 Flashcards
1) What is the aim of asthma management?
1) Achieve control of condition
What are the 2 types of asthma management?
How can we educate patients?
Avoid NSAIDs (e.g. ibuprofen)
What is a personalised action plan?
State pharmacalogical treatments for asthma
Short-Acting Beta
Agonist (SABA)
Inhaled Corticosteroids (ICS)
What is the mechanism of action of SABA?
What is its primary role?
How is it delivered in chronic management?
Examples: Salbutamol or
Terbutaline
Mechanism of action:
* Beta-2 adrenoreceptor agonist
binds to Beta-2 receptor
* Activates adenyl cyclase resulting
in conversion of ATP to cAMP
* Promotes bronchodilation.
“Reliever” - Control of symptoms
In chronic management usually
delivered using inhaler
* >3x use per week
State common side effect of Salbutamol
Where else can beta 2 receptors be found?
Arrhythmias/Tachycardia
Headache
Tremor
-Heart
-Skeletal muscle
What is the purpose of inhaled corticosteroids?
Mechanism of action
Examples: beclomethasone dipropionate, fluticasone propionate or budesonide
“Preventer” - controls underlying condition
Reduce inflammation in airways but not bronchodilators
Aim for lowest dose possible to control condition (prevents unnecessary side effects)
Side effects of ICS
Answer to MCQ - Oral candidiasis
What is a common risk factor of taking long term high dose inhaled steroids?
Increase risk of systemic side effects:
- SLOW GROWTH IN CHILREN
How do we prevent side effects of ICS?
Aim for lowest dose possible to control condition
Maintain good oral health
Use spacer
Rinse mouth / brush teeth after using ICS
How do we monitor control in adults with asthma?
We need to look at
What 3 questions should doctors ask patients who have asthma?
How does LABA act?
Long-Acting Beta Agonist
Examples: Salmeterol/Formoterol
Work on Beta-2 receptors
Used in combination with ICS and/or LAMA in treatment of asthma or COPD
How does LTRA act?
Leukotriene Receptor
Antagonist
Example: Montelukast
Given orally
LTRAs block the effects of
cysteinyl leukotriene at the
CysLT1 receptors
Cysteinyl leukotrienes - cause inflammattion, narrow airways, produce mucus
What is MART?
Advantages:
Maintenance and Reliever Therapy
ICS and LABA can be given in combination in one inhaler
Advantages
* Ease of use
* Better adherence – improved patient safety
* Reduced prescription costs
What are the different types of inhalers
How do we manage acute asthma?
- Oxygen (high flow):
-During asthma, oxygen levels drop. Administering high flow oxygen helps to keep oxygan saturation of blood between 94-98%, ensuring vital organs are getting enough oxygen. - Nebulaised salbutamol:
Salbutamol is a bronchodilator that helps relax and open up the airways. It is given through a nebulizer, which turns the medication into a fine mist that can be inhaled.
Continuous if necessary: If the patient doesn’t respond to initial doses, salbutamol can be given continuously. - Oxygen drive: The nebulized salbutamol can be delivered using oxygen as the driving gas to ensure both the medication and oxygen are delivered to the lungs effectively.
- If not responding / acute life threatening symptoms, add nebulised ipratropium: ipratropium is another bronchodilator. Often added to treatment if salbutamol is not effective.
- Oral prednisolone / IV hydrocortisone
Steroids, reduce inflammation in airways. - Intravenous magnesium sulphate: used for severe life threatening asthma. Magnesium sulphate relaxes muscles around airways, reduces inflammation
- Consider IV aminophylline if no improvement and life-threatening features not responding to above treatment
- Treat any underlying cause
