Resp - Asthma Management, COPD Management Flashcards
Asthma management - Acute management
O SHIT ME
Oxygen
Salbutamol
Hydrocortisone IV
Ipratropium Bromide
Theophylline (Aminophylline IV)
Magnesium Sulphate IV
Escalate
Asthma management - under what criteria would you admit someone?
O2 sats <92%
Exhausted
Marked reduction in PEFR
No clinical response to treatment
Asthma management - chronic management pathway
- Inhaled SALBUTAMOL (SABA)
- Add Beclometasone (ICS)
- Add Salmeterol (LABA)
- Good response = continue
- Response, control poor = increase ICS to 800mcg
- No response = try MONTELUKAST (LTRA)
- Increase ICS Beclometasone to max dose 2000mcg
- Consider oral steroid + referral to specialist services
COPD management - stepwise stable management?
- SABA or SAMA PRN basis
- No steroid response or no asthma features = LABA + LAMA
- steroid response/asthma features = LABA + ICS
- Escalate to triple therapy (TT), LABA + LAMA + ICS:
- Already on LABA + LAMA = 3 month trial on TT if clinical features impact QoL, if no improvement, revert back to LABA + LAMA
- Already on LABA + LAMA = offer TT if 1 severe, or 2 moderate acute exacerbations within 1 year
- Already on LABA + ICS = offer TT if clinical features impact QoL, or 1 severe or 2 moderate exacerbations within 1 year
COPD management - management of acute exacerbations
- O2 - aim for 88-92% on venturi masks to prevent T2RF
- Bronchodilators:
SALBUTAMOL - nebulsied 2.5mg back to back, once stable QDS +PRN
Ipratropium - nebulised 500mcg - Corticosteroids:
Oral Prednisolone 30mg once daily for 5 days - Antibiotics:
Follow local guidelines
Co-amoxiclav or Doxycycline typically used
COPD management - drug acronym examples
SABA, Short-acting beta-agonist = Salbutamol
LABA, Long-acting beta-agonist = Salmeterol
SAMA, Short-acting muscarinic antagonist = Ipratropirum
LAMA, Long-acting muscarinic antagonist = Tiotropium
ICS = Inhaled Corticosteroid = Beclometasone
LABA-ICS: Seretide (salmeterol/fluticasone)
LABA-LAMA: Ultibro (indacaterol/glycopyrronium)
LABA-LAMA-ICS: Trimbow (formoterol/glycopyrronium/beclometasone)
Pulmonary function tests - how does FEV1, FVC and FEV1/FVC look in an obstructive lung disease picture? What are some examples of conditions too?
FEV1 - SIGNIFICANTLY Reduced
FVC - Normal or reduced
FEV1/FVC - Reduced
Examples - Asthma, COPD, Bronchiectasis, Bronchiolitis obliterans
Pulmonary function test - how does FEV1, FVC and FEV1/FVC look in a restrictive lung disease picture? What are some examples of conditions too?
FEV1 - reduced
FVC - significantly reduced
FEV1% (FEV1/FVC) - normal or increased
Examples - Pulmonary fibrosis, sarcoidosis, severe obesity, neuromuscular disorders, asbestosis