Treatment Of Asthma Flashcards
Asthma management cycle
Review- control. Lung function, patient satisfaction
Assess- confirm diagnosis, r/f , comorbidities, tech/adherence
Adjust- rx
Best way to treat ti decease exacerbation
Feno
Eosinophil
How do u choose device
Technique if he can use
Adherence - will he use
Cost
When do u use track 2
If pt is stable/ gud adherence/no exacerbation In past one year on this therapy
What is mart
Maintenance and reliever therapy
What is controller
Containing ics
Things to do before stepping up
Technique Adherence Exposure Confirm diagnosis Comorb
What is the usual dose of sos foracort
200/6 mcg
Max- 72 mcg of formeterol
Name anti ige and indications
Omalizumab
>6yrs- mod and severe allergic asthma
Anti il-5 /5r
Mepolizumabs/c 6yrs
Resli- 18yrs
Benralizumab- 12yrs
Anti il4 receptor
Dupilumab >6yrs requiring maintenance ocs
Anti tslp
Thymic stromal lipoprotein
Tezepelumamab
12 yrs and severe asthma
Add on therapies
Sputum guided - more than 3 eosinophilia
Bronchial thermoplasty
Low dose Ics - <75mg/day prednisone equivalent
How to u step up
What is day to day step up
Short term step up
Sustained step up
Who are on sos laba+ics- increase number of doses needed to dec exacerbation
1-2 wks- increase in maintenance ics dise as per action plan
2-3 months- who are not better with low dose ics
How do u step down
Factors for risk of exacerbation after step down
By one step
To minimum effective dose after 2-3 month
History of exacerbation, emergency visit, low baseline fev1
Allergen immunotherapy types and indications
Advantages
Mc allergens- dust mites/ pollen S/c and s/l In pts with allergic sensitization If fev1>70 Persistent symptoms Ld-md ics Adv: decrease dose if steroids , symptoms better
Vaccination
Influenza ✅
Pneumococcal- no evidence
Non pharmacological
Smoking Diet Avoid pollution/occupational Exercise Weight Food chemicals
Comorbs
Obesity- wt loss. Inc ics- osa
Gerd- ppi
Ar- polyposis- omalizumAb
Eia- bc worsens after cessation
Pregnancy
Ics laba to continue Monte Theophylline No risk to baby Omalizumab✅
How do u treat exacerbation
02
Saba
Iv cs
Difficult to treat asthma
Uncontrolled despite step 5
Severe asthma
Uncontrolled despite adherents optimized high dose ics-laba therapy and treatment of contributing factors or worsens on step down
How do u manage difficult to treat asthma
Add on depending on phenotypes
Low dose ocs- last
Definition of Uncontrolled asthma
Poor symptom control
Frequent exacerbation 2 requiring ocs
Or serous exacerbation 1 or more requiring hospitalization
