Treatment of Asthma Flashcards
Definition of Asthma
Chronic inflammatory disorder in susceptible individuals
- reversible either spontaneously / w/ treatment
Symptoms of Asthma
Wheezing/coughing
Chest tightening
Breathlessness
Childhood
Immediate phase of bronchoconstriction
Bronchospasm with wheezing
Late phase of bronchoconstriction
Further inflammation + airway obstruction Cough + Sputum production
How to diagnose asthma
Medical History Signs + symptoms Lung function tests - spirometry - PEF (peak expiratory flow)
Chronic Asthma Treatment
Intermittent Reliever therapy
1) Regular preventer therapy (mild persistent asthma)
2) Initial-add on therapy (moderate persistent)
3) Additional add-on therapy
4) High dose therapy
5) Continuous/frequent use of oral steroids
Intermittent reliever therapy
All patients with symptomatic asthma use
Reliever - short-acting Beta2 agonist e.g. salbutamol) when needed
- consider stepping up if using 3 doses a week or more
2 types of medicines to treat chronic asthma
Controllers - taken daily to keep asthma under control
Relievers - used on a as-needed basis to reverse bronchoconstriction quickly
Regular preventer therapy
Confirmed diagnosis of asthma
Need to be on a
- Inhaled corticosteroid (controller) = low dose
- Short-acting beta2 agonist (reliever)
Initial add-on therapy
Low dose inhaled corticosteroids + long-acting beta2 agonist (controller)
- Adults/children>5years = LABA/leukotriene receptor antagonist
- children<5years = LABAs not licensed, just add LTRA
Short-acting beta2 agonist
Additional add-on therapy
Increased inhaled corticosteroid dose + LABA (controller)
SABA (reliever)
If control on additional add-on therapy is still inadequate, what should be trialled instead?
LTRA
Prolonged release theophylline
LAMA (long-acting muscarinic antagonist) in adults
High dose therapies
Increased inhaled corticosteroids up to high doses
If ineffective, return to original dose + add on
- LTRA
- modified release theophylline
- oral beta2 agonist
- LAMA
Refer children to respiratory consultant
Continuous/frequent use of oral steroids
Daily steroids (prednisolone) + inhaled corticosteroids + LABA (controller) SABA (reliever)
Aims of asthma treatment/well controlled asthma
No daytime symptoms No night-time waking due to asthma No need for rescue meds No exacerbations No limitations on activity - including exercise Normal lung function Minimal side effects from medicines
What to do when a patient is suspected with asthma
Trial them on inhaled steroids for 6 weeks
Asthma symptom questionnaire
Assess response by spirometry/home peak expiratory flow
- if response is good = confirm asthma diagnosis + personalised asthma action plan
- if response is poor = check adherence + inhaler technique; + arrange further tests
What to do before stepping up or initiating new drug therapy
Check adherence
Check inhaler technique
Eliminate trigger factors
Non-pharmacological management of asthma
Offer appropriate support to stop smoking
Weight loss interventions
Breathing exercise problems
Newer treatments for chronic asthma
Omalizumab - NICE approved
- for adults, teens + children>6years
- add-on to optimise standard therapy
- prophylaxis of severe, persistent allergic asthma
- dose/per body weight/ IgE level
What factors should be monitored + recorded in adults suffering from asthma in primary care
Symptomatic asthma control Lung function assessed by spirometry/PEF Inhaler technique Adherence Bronchodilator reliance Asthma attacks, oral corticosteroid use + time off work since last assessment
Acute asthma treatment
Oxygen SABA Ipratropium bromide (bronchodilator) Corticosteroids Magnesium Aminophyline
How to treat a acute moderate asthma
Start treatment at home or in surgery (GP) + assess response
Inhaled SABA using spacer/nebuliser
Prednisolone 40-50mg for at least 5 days
- if response is poor, send to hospital
How to diagnose acute moderate asthma
Increasing symptoms
Peak flow>50% predicted/best
No features of acute severe asthma
How to diagnose acute severe asthma
Cannot complete sentences in 1 breath
Respiration>25 breaths/min
Pulse>110 beats/min
How to treat acute severe asthma
Start treatment + send to hospital High flow oxygen Inhaled SABA + spacer/nebuliser Oral prednisolone/IV hydrocortisone - consider IV beta2 agonist, aminophylline, magnesium sulphate
How to diagnose acute life-threatening asthma
Peak flow < 33% best or predicted Arterial oxygen saturation (SpO2) < 92% Partial arterial pressure of oxygen (PaO2) < 8kPa Normal partial arterial pressure of carbon dioxide (PaCO2) (4.6–6.0kPa) Silent chest Cyanosis Poor respiratory effort Arrhythmia Exhaustion Altered conscious level Hypotension
How to treat acute life-threatening asthma
Start treatment + send to hospital
IV beta2 agonist
Aminophylline
Magnesium Sulphate
Personalised care in Asthma
Instruction on how to recognise signs of worsening asthma
Advice on the prompt use of SABA + oral corticosteroids
Monitoring response to medicines
Contact information
Follow-up to assess asthma control
