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PHAM01 > Wk 14: Asthma > Flashcards

Wk 14: Asthma Flashcards

1
Q

What is the pathophysiology of early phase asthma?

A
  • Initiation of inflammatory cascade - IgE antibodies released
  • IgE activates mast cells
  • Leads to release of: leukotrienes, cytokines + histamines
  • Smooth muscle constriction + inflammation
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2
Q

How is asthma diagnosed in suspected asthma?

A
  • 6 wk treatment of ICS + SABA
  • Asses response: baseline, questionnaire, lung function test (spirometry/peak expiratory flow)
  • Improvement in symptoms + tests = asthma
  • Lack of improvement = alt diagnosis
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3
Q

What are the results of an obstructive patient in spirometry testing?

A
  • Low forced vital capacity (FVC)
  • Low forced expiratory volume in 1 second (FEV1)
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4
Q

What is suggestive of asthma in spirometry results?

A
  • Obstructive: FEV1/FVC <0.7
  • Positive: improvement in FEV1 of ≥ 12% w/ inc in vol of 200ml
  • Improvement in FEV1 of ≥ 400ml = asthma
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5
Q

Which objective lung function test is suitable for children?

A

Peak flow

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6
Q

How do you perform a peak flow?

A
  • Deep breath in + hold for 2 secs
  • Rapidly breathe out + record value
  • Do 3x morning + night + record best
  • Repeat twice daily for 2 wks
  • Take average from day + night
  • Take highest + lowest reading as percentage
  • 20% diff. = asthma
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7
Q

What is the BTS approach?

A

SABA prn for relief + ICS BD for prevention

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8
Q

What are used for relievers + preventers?

A
  • Relievers: SABA (salbutamol, terbutaline)
  • Preventers: ICS + leukotriene receptor antagonists + LABAs
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9
Q

What are the steps for the management of asthma?

A
  • Regular preventer: low dose ICS
  • Initial add on: + inhaled LABA
  • Additional: Inc ICS to medium or add LTRA, if no response to LABA - stop
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10
Q

When would you step up therapies?

A
  • Asthma attack in last 2 years
  • Inhaled SABA 3x per wk
  • Symptomatic 3x per wk
  • Waking 1 night per wk
  • Affects daily activities
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11
Q

What happens when a patient is stable?

A

Dec ICS dose 25-50% every 3 months

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12
Q

SABA: examples, onset, duration of action + s/e

A
  • Salbutamol + terbutaline
  • Onset: 5-110 mins
  • Duration:4-6hrs
  • Fine tremor + tachycardia
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13
Q

ICS: examples, onset, duration of action + s/e

A
  • Beclomethasone, budesonide
  • Onset: 60 mins
  • Duration: 12hrs
  • Oral thrush
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14
Q

LABA: examples, onset, duration of action + s/e

A
  • Formoterol, Salmeterol
  • Onset: 5-10 mins (formeterol), 1-2 hrs
  • Duration: 12hrs
  • Tremors + tachycardia
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15
Q

LTRA: examples, onset, duration of action + s/e

A
  • Montelukast
  • Onset: 3 hrs
  • Duration: 24hrs
  • Neuropsychiatric
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16
Q

Do you need a SABA if initiated on MART regime?

A

No

17
Q

What are the important points of ICS?

A
  • Prescribed ALL stages
  • Growth retardation
  • Brand prescribing
18
Q

What are examples of combination inhalers?

A
  • Fostair
  • DuoResp
  • Seretide
  • Relvar
19
Q

How do you monitor theophylline?

A
  • 5 days after starting
  • 3 days after dose change
  • 4-6hrs after dose
20
Q

What is MART regimes?

A
  • One inhaler for reliever + preventer
  • Contains last acting LABA + ICS
  • For: 18+, poor control despite regular preventatives, prefer one inhaler
  • Maintenance in morning + evening
  • If symptoms, can use extra puffs
21
Q

Which inhalers are licensed for MART regimes?

A
  • Fostair 100/6
  • DuoResp 160/4.5
  • Symbicort 100/6 or 200/6
22
Q

What are examples of pMDI?

A
  • Salbutamol evohaler
  • Fostair + seretide evohaler
23
Q

What is an example of a soft mist inhaler?

A

Spiriva respimat

24
Q

What are examples of dry powder inhalers?

A
  • Turbohaler
  • Breath actuated
  • NEXThaler
  • Accuhaler
  • Ellipta
  • Breezhaler
  • Genuair
25
Q

What are the symptoms of acute asthma?

A
  • Deteriorating symptoms over hrs + days
  • Inc breathlessness, wheezing, coughing, tightness
  • Difficulty talking
  • Tachycardia
  • Red PEFR
  • Red oxygen sats
26
Q

What classifies as moderate asthma?

A
  • PEF >50-75%
  • SpO2 >92%
  • Normal speech
  • Respiration <25
  • Pulse <110
27
Q

What classifies as acute severe asthma?

A
  • PEF 33-50%
  • SpO2 >92%
  • Can’t complete sentence
  • Respiration >25
  • Pulse >110
28
Q

What classifies as life threatening asthma?

A
  • PEF <33%
  • SpO2 <92%
  • Silent
  • Arrhythmia
  • Exhausted
29
Q

How do you manage and treat moderate asthma?

A
  • B2 bronchodilator (4 puffs then 2 every 2 mins)

PEF >50-75%:
- Nebuliser (salbutamol 5mg)

  • Pred 40-50mg
30
Q

How do you manage + treat acute severe asthma/life threatening asthma?

A
  • Oxygen
  • B2 bronchodilator (4 puffs then 2 every 2 mins)
  • Nebuliser (salbutamol 5mg)
  • Pred 40-50mg or IV hydrocortisone 100mg
  • No response: admit
31
Q

What are the key treatments of acute asthma?

A
  • Oxygen
  • Steroids
  • SABA
  • SAMA
  • Mg sulphate
32
Q

Give examples of support self management that can be offered

A
  • Education
  • Avoid triggers
  • Stop smoking
  • Breathing exercise
  • Ideal Body weight

PHAM01 (47 decks)

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