Resp 7.2

Question 1

1) What is the aim of asthma management?

Answer 1

1) Achieve control of condition

Question 2

What are the 2 types of asthma management?

Answer 2

Question 3

How can we educate patients?

Answer 3

Avoid NSAIDs (e.g. ibuprofen)

Question 4

What is a personalised action plan?

Answer 4

Question 5

State pharmacalogical treatments for asthma

Answer 5

Short-Acting Beta
Agonist (SABA)

Inhaled Corticosteroids (ICS)

Question 6

What is the mechanism of action of SABA?

What is its primary role?

How is it delivered in chronic management?

Answer 6

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

Question 7

State common side effect of Salbutamol

Where else can beta 2 receptors be found?

Answer 7

Arrhythmias/Tachycardia
Headache
Tremor

-Heart
-Skeletal muscle

Question 8

What is the purpose of inhaled corticosteroids?

Mechanism of action

Answer 8

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)

Question 9

Side effects of ICS

Answer 9

Answer to MCQ - Oral candidiasis

Question 10

What is a common risk factor of taking long term high dose inhaled steroids?

Answer 10

Increase risk of systemic side effects:

1. SLOW GROWTH IN CHILREN

Question 11

How do we prevent side effects of ICS?

Answer 11

Aim for lowest dose possible to control condition

Maintain good oral health
Use spacer
Rinse mouth / brush teeth after using ICS

Question 12

How do we monitor control in adults with asthma?

Answer 12

We need to look at

Question 13

What 3 questions should doctors ask patients who have asthma?

Answer 13

Question 14

How does LABA act?

Answer 14

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

Question 15

How does LTRA act?

Answer 15

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

Question 16

What is MART?
Advantages:

Answer 16

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

Question 17

What are the different types of inhalers

Answer 17

Question 18

How do we manage acute asthma?

Answer 18

1. 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.
2. 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.
3. 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.
4. If not responding / acute life threatening symptoms, add nebulised ipratropium: ipratropium is another bronchodilator. Often added to treatment if salbutamol is not effective.
5. Oral prednisolone / IV hydrocortisone
   Steroids, reduce inflammation in airways.
6. Intravenous magnesium sulphate: used for severe life threatening asthma. Magnesium sulphate relaxes muscles around airways, reduces inflammation
7. Consider IV aminophylline if no improvement and life-threatening features not responding to above treatment
8. Treat any underlying cause