Respiratory Medications & Metered Dose Inhalers

Question 1

What are the 3 groups of asthma medications?

Answer 1

• Relievers
• Preventers
• Symptom controllers

Question 2

What is another name for relievers?

Answer 2

Short acting Beta 2 agonists (SABA)

Question 3

What is the role of relievers?

Answer 3

• Smooth muscle relaxation in airway wall
• Help relieve bronchospasm
• First line of treatment
• Increasing use indicates loss of control

Question 4

When should preventers be used?

Answer 4

• Patient requires SABA 3 or more times per week
• Exacerbations are infrequent but severe/life threatening
• Exacerbation in last year
• Asthma interferes with PA despite appropriate pre-treatment
• Patient wakes at night due to asthma
• Impaired lung function

Question 5

What is the main choice for preventers?

Answer 5

Inhaled corticosteroids - reduce inflammatory response of airways

Question 6

What should adults with uncontrolled asthma consider?

Answer 6

Adding LABA to low dose corticosteroid

Question 7

What are the adverse effects of inhaled corticosteroids

Answer 7

• Oral candidiasis (thrush)
• Dysphonia (voice sounds rough)

Possible:

• Adrenal suppression
• Bone loss
• Skin thinning
• Cataract formation
• Growth/metabolic changes
• Behavioural abnormalities

Question 8

What are the recommended guidelines for preventers?

Answer 8

• Aim for minimum dose to achieve control (review 3-6 months)

Question 9

What are symptom controllers also known as?

Answer 9

Anti-muscarinic (anti-cholinergic) or long acting beta 2 agonists (LABA)

Question 10

What are the recommended guidelines for symptom controllers?

Answer 10

• Used in combination with inhaled corticosteroids
• Usually taken once or twice daily only
• Use lowest dose required to maintain control

Question 11

What is a risk associated with LABAs?

Answer 11

May increase risk of serious asthma exacerbations & asthma-related death

Question 12

What are some of the other asthma medications?

Answer 12

• Antibacterials (for serious infections)
• Flu vaccine - should be considered for patients with severe asthma
• Anti-histamines (not useful)
• Sedatives (CI in acute asthma)
• Immunotherapy

Question 13

What does exercise-induced asthma indicate?

Answer 13

• Under-treatment of asthma
• May be the only symptom of asthma in some people
• Can be reduced by improving control

Question 14

What is the first line of treatment for exercise-induced asthma?

Answer 14

• Inhaled SABAs (20-30 mins before exercise)

- Tolerance may develop with regular use of LABAs

Question 15

What are the treatments for acute asthma?

Answer 15

• Inhaled SABAs (first line)
• MDI with large volume spacer
• High flow oxygen to achieve SpO2 > 92%
• IV medications if severe & unresponsive to other treatments

Question 16

What needs to be done before starting drug treatment in COPD?

Answer 16

• Confirm diagnosis (exclude asthma - spirometry)
• Assess severity
• Actively encourage smoking cessation
• Identify & avoid risk factors (smoking, dust, fumes, pollutants)

Question 17

What is the role of short acting bronchodilators?

Answer 17

• Relieve symptoms & improve exercise tolerance
• Initial COPD management as required for symptom relief or on regular basis
• Individualised based on response, adverse effects & patient preference

Question 18

What type of patients are long acting bronchodilators useful for?

Answer 18

Patients who remain symptomatic despite SABAs or those with exacerbations >2/year

Question 19

What is the benefit of long acting bronchodilators over SABA?

Answer 19

• Reduce symptoms
• Fewer exacerbations
• Lower rate of hospitalisation
• Exercise tolerance & QOL improved

Question 20

What are the benefits of inhaled corticosteroids?

Answer 20

In patients with COPD & FEV1 < 50%:

• Reduced frequency of exacerbations
• Improved QOL

Question 21

What are the guidelines for using inhaled corticosteroids?

Answer 21

• Add to long acting bronchodilators in patients with 2 or more exacerbations per year
• Withdrawal can lead to exacerbation

Question 22

What does the evidence show regarding use of expectorants & mucolytics in COPD?

Answer 22

• Limited evidence for expectorants

- Small benefit of mucolytics, but not usually recommended

Question 23

What COPD medications should be used in an exacerbation?

Answer 23

• Short acting bronchodilators (increase dose/frequency)
• Oral corticosteroids (14 days)
• Antibacterials (clinical signs of infection)

Question 24

What are the benefits of oral corticosteroids in treating exacerbations of COPD?

Answer 24

• Shorten recovery time
• Reduce severity of exacerbation
• May reduce risk of early relapse