Respiratory Flashcards
If asthma is uncontrolled on a low dose of inhaled corticosteroid and a leukotriene receptor antagonist as maintenance therapy, what should be added?
a LABA in combination with the inhaled corticosteroid should be offered with or without continued leukotriene receptor antagonist treatment, depending on the response achieved from the leukotriene receptor antagonist
What is a MART regimen?
Maintenance And Reliever Therapy—a combination of an inhaled corticosteroid and a fast-acting LABA such as formoterol in a single inhaler), with a low dose of inhaled corticosteroid as maintenance.
If asthma remains uncontrolled on a MART regimen with a low dose of inhaled corticosteroid as maintenance with or without a leukotriene antagonist, what should be added?
consider increasing to a moderate dose of inhaled corticosteroid (either continuing a MART regimen or changing to a fixed-dose regimen of an inhaled corticosteroid and a LABA, with a short-acting beta2 agonist as reliever therapy).
When should you consider decreasing asthma treatment?
Consider decreasing maintenance therapy when a patient’s asthma has been controlled with their current maintenance therapy for at least three months. decreasing the dose of ICS by approximately 25–50% each time
What is the first line treatment for patients with acute asthma?
First-line treatment for acute asthma is a high-dose inhaled short-acting beta2 agonist (salbutamol or terbutaline sulfate) given as soon as possible. A pressurised metered dose inhaler with spacer device is preferred in patients with non-life-threatening acute asthma.
What dose and duration of prednisolone should be given for an acute asthma attack in adults?
40-50mg for at least five days
When might magnesium sulphate be given in an acute asthma attack?
There is some evidence that magnesium sulfate has bronchodilator effects. A single intravenous dose of magnesium sulfate may be considered in patients with severe acute asthma (peak flow < 50% best or predicted) who have not had a good initial response to inhaled bronchodilator therapy [unlicensed use
When might aminophylline be given for an acute asthma attack?
In an acute asthma attack, intravenous aminophylline is not likely to produce any additional bronchodilation compared to standard therapy with inhaled bronchodilators and corticosteroids. However, in some patients with near-fatal or life-threatening acute asthma with a poor response to initial therapy, intravenous aminophylline may provide some benefit
How long should prednisolone be given for in an acute asthma attack in a child?
Treatment for 3 days is usually sufficient, but the lenght of the course should be tailored to the number of days necessary to bring about recovery
Theophylline causes what electrolyte disturbance?
Hypokalemia
Patients with COPD requiring regular preventative therapy and an FEV1 is >50% should be offered what treatment?
If the Forced Expiratory Volume in 1 second (FEV1), is 50% of predicted or more, either a long-acting antimuscarinic bronchodilator or a long-acting beta2 agonist should be used
Patients with COPD requiring regular preventative therapy and an FEV1 <50% should be offered what treatment?
If FEV1 is less than 50% of predicted, either a long-acting antimuscarinic bronchodilator or a long-acting beta2 agonist with a corticosteroid in a combination inhaler should be used.
If symptoms of COPD persist despite triple inhaler therapy, what can be added?
If symptoms persist or if the patient is unable to use an inhaler, oral modified-release aminophylline or theophylline can be used.
During an acute exacerbation of COPD what should a patient be given?
A short course of oral prednisolone 30mg for 7-14 days.
bronchodilator therapy can be administered through a nebuliser if necessary and oxygen given if appropriate. Aminophylline can be given intravenously if response to nebulised bronchodilators is poor.
Antibacterial treatment is required if sputum becomes more purulent than usual, or if there are other signs of infection
How many hours a day does oxygen need to be given to prolong survival in COPD?
Long-term administration of oxygen (usually at least 15 hours daily) prolongs survival in some patients with chronic obstructive pulmonary disease.
