Respiratory Flashcards
What are the signs/symptoms of asthma?
cough, wheeze & chest tightness (with SOB)
In the NICE adult treatment guidelines for asthma, “adults” are considered to be those aged (…) and over
aged 17 years and over
The KPOP boyband ‘seventeen’ sang a song called very nice
In the BTS/SIGN adult treatment guidelines, “adults” are considered to be those aged (…) and over
aged 12 years and over
there are twelve zodiac signs
What is MART (maintenance and reliever therapy)?
MART is a combination of a ICS + LABA in one inhaler
The LABA component is fast acting. F for Formoterol.
Give TWO examples of a MART inhaler
MART inhalers: keep in the fridge
Fostair (Beclomethasone + F)
Symbicort (Budesonide + F)
F is the fast-acting LABA called Formoterol.
Give an example of a leukotriene receptor antagonist (LTRA)
leuk = Monteleukast
Give an example of a long-acting muscarinic receptor antagonist (LAMA)
U TAG
LAMA end with the letter M = Tiotropium**
NICE guidelines for adults (17y+)
Step 1?
Examples?
SIM LABA MART INCREASE2 LAMAT
S = SABA prn
Examples: Salbutamol & Terbutaline
When to step up asthma treatment?
If the inhaler fails and one of the below applies:
- asthma attack more than (…) a WEEK
- Waking up at (…) because of an asthma attack
- Poorly controlled asthma with a (…) alone
- asthma attack more than 3 times a WEEK
- Waking up at night because of an asthma attack
- Poorly controlled asthma with SABA alone
NICE guidelines for adults (17y+)
Step 2?
Max doses?
SIM LABA MART INCREASE2 LAMAT
I = ICS (low-dose)
Max for low dose ICS in adults
Beclomethasone 500mcg daily
Budesonide 400mcg daily
NICE guidelines for adults (17y+)
Step 3 (options)?
Step 3 - add on options?
Using NICE asthma guidelines (17y and over)
Consider the following scenerio: 20y-old patient with asthma prescribed salbutamol, budesonide 400mcg, montelukast and Salmeterol; after a medication review their GP concludes that their asthma is not well controlled & the LTRA is NOT showing benefit anymore.
use MART inhaler (low dose ICS + LABA)
- NB - MART @ any point can change to 2 separate inhalers as ICS dose slowly increases; Patient may still be on LTRA if it still shows some benefits.*
- ****
If this doesn’t help INCREASE2 = increase ICS dose to moderate then to high if needed
What is next?
NICE asthma guidelines (17y +)
- SABA
- SABA + low ICS
- SABA + low ICS + LTRA
- SABA + low ICS + LABA +/- LTRA
- SABA + low MART +/- LTRA
- SABA + mod MART +/- LTRA
- SABA + high MART +/- LTRA
- (…)
- Refer to specialist
SIM LABA MART INCREASE2 LAMAT
- Add LAMA (Tiotropium) or Theophylline
NB - @ any point MART can be separated back to ICS and LABA.
NB - LTRA may be stopped on continued depending on if providing benefit
NICE asthma guidelines (<5y)
The THREE main inhaler classes used are…
SIM = SABA, ICS, Montelukast
- Notes say SIT but it is wrong should be SIM!*
- Trial the ICS for 8 weeks. If improvement but an asthma attack occurs within a month of use re-initiate ICS but at a low dose for 8 weeks. If the same thing occurs again after stopping use a moderate dose for 8 weeks. If that fails, step-up treatment.*
- Use Montelukast if the child cannot use ICS for any reason. Note Mometasone is not suitable for <5y olds.*
NICE asthma guidelines (<5y)
Step 1 involves starting the child on a SABA inhaler to be delivered with the use of a (…)
spacer
NICE asthma guidelines (< 5y)
If the inhaler fails and one of the below applies:
- asthma attack more than 3x a WEEK
- Waking up at night because of an asthma attack
- Poorly controlled asthma with SABA alone
- using a (..) in a MONTH
step-up treatment
Step 1 - NICE asthma guidelines (<5y)
If the inhaler fails and one of the below applies:
- asthma attack more than (…) a WEEK
- Waking up at (…) because of an asthma attack
- Poorly controlled asthma with SABA alone
- using a full inhaler in a MONTH (200 doses in 28 days)
step-up treatment
Note: 4 step up points for paeds different to those aged 5-16 and 17y+