Therapies for Asthma (6.2)

Question 1

What is step one on the treatment ladder of Asthma?

Answer 1

Short acting Beta2 Agonists

Mild intermittent asthma - relieves symptoms of bronchoconstriction by causing relaxation.

Question 2

Name a fast onset, short duration beta2 agonist

Answer 2

Inhaled Salbutamol
Inhaled Terbutaline
Relievers, commonly used

Question 3

Name a fast onset, long duration beta2 agonist

Answer 3

Inhaled Formoterol

Question 4

Name a slow onset, short duration beta2 agonist

Answer 4

Oral Terbutaline
Oral Salbutamol
Oral Formoterol
Rarely used

Question 5

Name a slow onset, long duration beta2 agonst

Answer 5

Inhaled Salmeterol
Oral Bambuterol
Preventers

Question 6

What are the main ADRs of Beta2 agonists?

Answer 6

Tachycardia
Palpitations
Tremors

Question 7

What is step two on the treatment ladder for Asthma?

Answer 7

Add a regular preventer therapy

Question 8

What preventer therapies are available for asthma patients?

Answer 8

Inhaled corticosteroids (immunosuppressive activity)

Question 9

How do inhaled corticosteroids help in asthma?

Answer 9

Increase symptom relief
Increase lung function
Decrease Exacerbations
eosinophillic positive patients respond much better than negative ones

Question 10

What is step three in the asthma treatment ladder?

Answer 10

Check compliance and inhaler technique
Identity and eliminate trigger factors
Add a long acting beta2 agonist (formoterol, salmeterol) with inhaled corticosteroids

Question 11

Give an example of a combined inhaler

Answer 11

Budesonide & Formoterol

Fluticasone & Salmeterol

Question 12

Why are combined inhalers better than two separate ones?

Answer 12

Increased compliance due to ease of use
One prescription
Ensures a corticosteroid is taken with a LABA as it is potentially harmful to take a LABA without a corticosteroid.

Question 13

What is step four of the treatment ladder for asthma?

Answer 13

Increase the dose of the inhaled corticosteroid
Consider alternative add ons such as Leukotriene receptor antagonists, Methylaxanthines (adenosine receptor antagonists), anticholinergics/antimuscarinics

Question 14

What is the action of Leukotriene receptor antagonists?

Answer 14

Block LTC4 (released form mast cells and eosinophils) as it can induce asthma. 
Decrease mucus, oedema and constriction

Question 15

What are the ADRs of Methylaxanthines?

Answer 15

Arrhythmias
Fits
narrow therapeutic window

Question 16

What are the ADRs of anticholinergics/antimuscarinics?

Answer 16

Dry mouth

Urinary retention

Question 17

What is step five in the asthma treatment ladder?

Answer 17

Add oral steroids

Consider IgE therapy in patients where oral steroids have been ineffective

Question 18

What sized particles reach the oropharynx?

Answer 18

10 microns

Question 19

What sized particles reach the small airways?

Answer 19

1-5 microns

Question 20

What sized particles reach the alveoli?

Answer 20

0.5 microns

Question 21

What is acute severe asthma?

Answer 21

Patient presents with;
Inability to compete sentences due to SOB
Pulse >110 beats per minute
Resp rate >25 per minute
Peak flow of 33->50%

Question 22

What are some of the life threatening features of acute severe asthma?

Answer 22

Peak expiratory flow 4.5kPa
Exhaustion
Hypotension
Confusion
Bradycardia

Question 23

What is the treatment plan for acute severe asthma?

Answer 23

High flow O2

• > nebulised salbutamol
• > oral corticosteroid for 10-14 days
• > nebulised ipratropium bromide
• > IV aminophylline