RESP SYSTEM- ASTHMA + COPD Flashcards
What are the 3 types of acute asthma?
Moderate
Severe
Life-threatening
What are 4 moderate acute asthma characteristics?
Peak flow more than 50%
Able to say full sentence
O2 level > 92%
Resp rate is less than 30 in children above 5
Resp rate < 40 between 1-5 years
What are 4 severe acute asthma characteristics?
Peak flow 33-50%
Unable to complete full sentence
Resp rate is >25 in adults, >30 children 5+, >40 children 1-5 years
HR >125bpm (5+)
HR >140 bpm (1-5 years)
What are 4 life-threatening acute asthma characteristics?
peak flow <33%
O2 <92%
cyanosis
silent chest
exhausted
hypotension
What is 1st line moderate acute asthma tx?
High dose SABA (salbutamol) via PMI + spacer
What is severe/ life threatening acute asthma treatment?
Hospital ASAP
High dose SABA via O2 nebuliser
+
Nebulised ipratropium (if poor response to above)
What IV drug is given in near FATAL acute asthma with poor response to initial therapy?
IV aminophylline
What is given to all patients after acute asthma attack?
Oral prednisolone
If contra- IV HC or IM methylpred
What to give if oral pred contra after acute asthma attack?
IV HC
or
IM methylpred
What to give hypoxic patients?
Supplementary oxygen (to keep O2 between 94-98)
1st line moderate acute asthma tx in people 2 + over?
SABA -salbutamol with PMI + pacer
1st line severe acute asthma tx in people 2 + over?
SABA with oxygen driver nebs
What is max salbutamol dose in acute asthma attack?
maximum of 10 puffs of salbutamol via a spacer
What 3 steps to do if children under 2 with acute asthma attack?
Hospital ASAP
Mod + severe = immediate o2 + maybe SABA
Combin Nebulised ipratropium if needed
What to give patients 2 and over after acute asthma attack?
3 days oral Prednisolone
What to add if poor initial response to SABA in acute asthma?
nebulised ipratropium
What to give if poor response to 1st line tx in child 2+?
IV MGSO4
What 3 lifestyle changes can help asthmatic patients?
Weight loss
Smoking cessation
Breathing exercise programmes
What is chronic asthma tx in adults?
Step 1 : SABA
Step 2 : SABA + low dose ICS
What 4 reasons to start ICS in asthma?
If uncontrolled by SABA alone - 3x a week
symptoms 3 x week
1 night time waking
More than 1 inhaler a month
What is step 3 of asthma treatment for adults?(NICE + BTS)
NICE = LTRA
sign/BTS - LABA fixed dose or MART
What is step 4 of NICE guidance for asthma tx in adults?
Add in LABA with/ or without LTRA
Can also add an ICS into MART
What is STEP 5 of asthma tx in adults?
Specialist - high dose ICS
What is tx for asthma in children over 5 compared to adults?
Same up to step 3
What age can LABA (e.g formeterol) be given in?
5 + years
What is tx of chronic asthma in children over 5?
Step 1: SABA
Step 2: SABA + very Low dose ICS
Step 3: SABA + ICS + LABA (sign)/LTRA (nice)
STEP 4: REPLACE LTRA WITH LABA
STEP 5: Increase ICS or specialist (steroids, MAB, tiotropium)
What is difference in asthma tx between adults and children over 5 ?
STEP 4: REPLACE LTRA WITH LABA
in children whereas adults can have both.
What age is tiotropium allowed in?
12+ years
What is asthma tx in children under 5?
Step 1 : SABA
Step 2: ICS paed moderate strength for 8 week trial
step 3: SABA + ICS + LTRA (if not working stop LTRA + refer)
What happens if children under 5 using more than 1 inhaler per month?
Urgent referral
How long is trial of ICS for asthma in children under 5?
8 week trial
When can asthma tx be dropped down?
If controlled for at least 3 months
review regularly
When are reductions of ICS considered?
Every 3 months - 25 to 50% reduction each time.
What are 7 signs of complete control?
No daytime symptoms
No night-time awaking
No attacks
No need for rescue meds
No exercise limitations
Normal lung function PEF >80%
Low SE from tx
What are 4 asthma symptoms?
Dyspnoea
wheezing
cough
chest tightness
What 2 drugs can trigger asthma?
BB
NSAIDs
What are 3 SEs of SABAs?
Hypokalaemia
CVS SE
tremors of hand
What is typical SABA dose?
1-2 puff QDS PRN
List 3 LABAs?
Fometerol
Salmeterol
Vilanterol
List 5 ICS?
Beclomethasone
Budesonide
Fluticasone
ciclesonide (OD)
mometasone (OD/BD)
What is LABA frequency?
BD
Where is fostair kept?
Fridge
What is more potent: Qvar or clenil?
Qvar 2x potent
What is more potent: fostair or CFC free inhaler?
Fostair
What is MHRA alert about ICS?
Prescribe beclomethasone CFC by brand
What are 3 main SEs of ICS?
Oral thrush
hoarse voice/sore throat
bronchospasm
what to do if bronchospasm with ICS inhaler?
Stop
If mild- SABA before use or use DPI
When is LTRA given in the day?
at night
What are 2 SEs for montelukast? (CN)
Neuropsychic reaction
Churg-strauss syndrome?
4 Symptoms of
Churg-strauss syndrome?
eosinophilia
cardiac issue
pulmonary issues
peripheral neuropathy
What is an MHRA warning regarding montelukast?
OCD symptoms + speech impairment
What is theophylline?
Xanthine Bronchodillator
What is dose frequency of theophylline?
every 12 hrs
What is therapeutic index of
theophylline?
10-20 mg/L