Treatment Summary - Chronic Asthma

Question 1

what is asthma?

Answer 1

chronic inflammatory condition of the airways, associate with airway hyperresponsiveness and airflow obstruction

Question 2

name the 4 main symptoms of asthma

Answer 2

1. cough
2. wheeze
3. chest tightness
4. breathlessness

Question 3

What does ACOS stand for and what is this characterised by?

Answer 3

asthma-COPD overlap symptoms
characterised by persistent airflow limitation displaying features of both asthma and COPD

Question 4

what 7 things define well controlled asthma

Answer 4

1. no night time waking due to asthma
2. no daytime symptoms
3. no asthma attakcs
4. no need for rescue medication
5. no limitations on actvity including exercise
6. normal lung function: FEV1 and/or peak expiratory flow > 80%
7. minimal side effects from treatment

Question 5

name the 3 main lifestyle changes people can do to help manage asthma

Answer 5

1. weight loss in overwight patients
2. advice on dangers of smoking
3. breathing exercises

Question 6

what should you do if a patient is using more than one reliever a month?

Answer 6

urgerntly assess their asthma

Question 7

name another SABA thats not salbutamol

Answer 7

terbutaline sulfate

Question 8

state the 6 main stages of the asthma management pathway

Answer 8

1. intermittent reliever therapy - SABA
2. regular preventer (maintenance) - low dose ICS
3. initial add - on therapy - LTRA or LABA or MART (BTS/SIGN)
4. additional controller therapies - LABA/MART/increase ICS/LAMA
5. contonuous or frequent use of oral corticosteroids
6. monoclonal antibiodies

Question 9

when should a low dose of ICS be started?

Answer 9

Any one of the following
- using SABA 3x a week or more
- symptomatic 3x a week or more
- waking at night due to asthma at least once a week
- BTS/SIGN: also if pt had asthma attach in last 2 years

Question 10

what inhaled corticosteroid is not recommended to be taken twice a day?

Answer 10

ciclesonide

Question 11

T/F: BTS/SIGN recommend prescribing inhalers by brand

Answer 11

true

Question 12

how long should a LTRA be used before a review of its effectiveness?

Answer 12

4 - 8 weeks

Question 13

what do BTS/SIGN recommened as add on therapy instead of a LTRA?
give 2 examples

Answer 13

LABA (salmterol or formoterol fumarate)

Question 14

when do BTS/SIGN recommened that MART regime is started?

Answer 14

patients with a history of asthma attacks on medium dose ICS alone or on a fixed dose ICS and LABA

Question 15

what is MART?
whats the point of this?

Answer 15

maintenance and reliver therapy - a combination of an ICS and fast acting LABA in a single inhaler.
Aim is to improve adherence and ensure LABA not taken alone without ICS

Question 16

name a short acting LABA
name a MART inhaler

Answer 16

formetrol
fostair, symbicort turbohaler

Question 17

What do NICE state as the first additional controller therapy?
When do NICE suggest MART therapy?

Answer 17

adding in a LABA
switch to MART is asthma remains uncontrolled with ICS and LABA maintenace therapy

Question 18

what do NICE suggest is asthma remains uncontrolled on a MART regimen?
whats the next step if this doesn’t work?

Answer 18

increase to a moderate ICS
increase to high dose ICS as part of a fixed dose regimen with a SABA or trial LAMA

Question 19

name two LAMAs

Answer 19

tiotropium
theophylline (modified-release)