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Asthma > Treatment > Flashcards

Treatment Flashcards

1
Q

SABA examples

A
  • Salbutamol
  • Terbutaline
  • Levalbuterol
  • Perbuterol
  • Albuterol
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2
Q

How do you treat an acute exacerbation?

A

Inhaled SABA along with ipratropium bromide (anticholinergic) provide best bronchodilation.

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3
Q

What is SBAR assessment?

A 
Handover of patient care
Situation
Background
Assessment
Recommendation
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4
Q

Process for identifying a CXR

A

Rotation - spinous process should be at midpoint between 2 ends of clavicles
Inspiration - 5-7 ribs anteriorly, 8-10 posterior
Penetration - if can see the vertebral bodies
Airway - trachea
Breathing - lung fields, lung markings, hilum, lymph nodes, shadowing or spots
Cardiac - heart size (PA <50%), look at borders
Diaphragm - right side is higher due to liver, costophrenic angles, gastric air bubble under left, calcification indicates asbestos
E - medical intervention, look behind heart and if 2 lines like a sail could be left lobar collapse, bones

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5
Q

What is and how to treat mild asthma?

A
  • Symptoms >2/week, 3-4/month for night symptoms
  • FEV1 >80%
  • SABA PRN and low dose ICS
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6
Q

What is and how to treat moderate asthma?

A
  • Symptoms 7/week, 1+/week night symptoms
  • FEV1 60-80%
  • SABA PRN + medium dose ICS or low dose ICS and LABA
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7
Q

What is and how to treat severe asthma?

A
  • Symptoms throughout everyday
  • Symptoms through every night
  • FEV1 <60%
    Treatment:
    1. SABA PRN + med dose ICS + LABA
    2. SABA PRN + high dose ICS + LABA
    3. SABA PRN + high dose ICS + LABA + oral corticosteroids
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8
Q

LABA examples

A
  • Salmeterol
  • Formoterol
    NEVER give without an ICS and NEVER for acute exacerbations
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9
Q

Corticosteroid examples

A 
Inhaled:
- Fluticasone
- Budenoside
- Mometasone
Oral or IV:
- Methylprednisolone
- Prednisolone
- Prednisone
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10
Q

What are mast cell stabilizers?

A

e.g. cromolyn sodium
Good for exercise or cold-induced asthma. Inhibit the release of histamine by mast cells and inhibit activation of eosinophils.

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11
Q

What are leukotriene receptor antagonists?

A

e.g. montelucast

Binds and inhibits leukotriene receptors, preventing bronchospasm and mucus production

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12
Q

Name an anti-IgE drug

A

Omalizumab

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13
Q

When should patients be admitted with a severe asthma attack?

A
  • all patients with life-threatening should be admitted in hospital
  • patients with features of severe acute asthma should also be admitted if they fail to respond to initial treatment
  • previous near-fatal asthma attack
  • pregnancy
  • an attack occurring despite already using oral corticosteroid and presentation at night
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14
Q

When do you use oxygen therapy?

A
  • if patients are hypoxaemic, it is important to start them on supplemental oxygen therapy
  • if patients are acutely unwell they should be started on 15L of supplemental via a non-rebreathe mask, which can then be titrated down to a flow rate where they are able to maintain a SpO₂ 94-98%.
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15
Q

What vaccinations should be given to asthma patients?

A
  • Flu vaccine annually

- One-off pneumococcal vaccine

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16
Q

Acute asthma exacerbation and B2 agonists

A
  • First-line give high-dose inhaled B2 agonists
  • IV B2 agonists for those where inhaled cannot be used reliably
  • In severe or life-threatening asthma a nebuliser (oxygen driven) is recommended
  • Can add nebulised ipratropium bromide with severe or life-threatening or with poor response to only B2 agonist
  • IV magnesium sulfate if bad initial response
17
Q

Acute asthma exacerbation and steroid therapy

A

Give to patients with any type of asthma attack. Continue prednisolone for 5 days after/until recovery.

18
Q

Discharge after exacerbation

A

Prednisolone for at least 5 days
Assess inhaler techniques
Self-management - triggers and what to do
Follow-up appointment at GP within 2 days
Resp specialist follow-up for at least 1 year with severe asthma attack

19
Q

Side effects of B2 agonists

A

Tremor
Tachycardia
Hypokalaemia
Restlessness

20
Q

What is the initial management of an asthma exacerbation?

A
  • Sit patient up
  • Give high flow oxygen
  • Nebulised B2 agonists every 15 mins
  • Nebulised ipratropium (repeat every 4 hours)
  • Steroids - prednisolone (40mg) or hydrocortisone (100mg)
  • If not responding - magnesium (1.2-2g IV over 20 mins) or consider IV aminophylline or B2 agonists

Asthma (4 decks)

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