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Chapter51
Asthma in Adults
13
Medical
Professional
10/02/2011

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Cards

Term
First line in asthma?
Definition
SABA - Salbutamol or Terbutaline used PRN
Term
If patient is using SABA > 4 times per week including for exercise purposes, what should be done?
Definition
Initiate Inhaled corticosteroid - beclomethasone, budesonide, ciclesonide, or fluticasone
Term
If the patient is taking SABA & Inhaled corticosteroid and asthma is still poorly controlled, what should be done?
Definition
Add LABA - Salmeterol or Formoterol

- Particularly useful in preventing nocturnal symptoms, and exercise induced symptoms
Term
Role of Ipratropium in Asthma
Definition
Not routinely used, but it is a useful alternate in patients susceptible to tremor or tachycardia from Beta Agonists
Term
Role of Tiotropium in asthma
Definition
Alternate to Ipratropium, which is a substitute for BA's. Tiotropium is dosed once daily, and advantage over ipratropium (3-4 times daily)
Term
Counseling point for inhaled corticosteroids.
Definition
Rinse mouth after use to decrease incidence of pharyngeal candidiasis.
Term
Which long acting LABA can be used as rescue therapy because of its fast onset?
Definition
Formoterol, NOT salmeterol
Term
LTRAs - Leukotriene Receptor antagonists

What are they?

Place in therapy?
Definition
Montelukast or Zafirlukast

Can be used in addition to inhaled corticosteroids instead of increasing corticosteroid dose. OR can be tried in mild asthmatic patients who refuse inhaled corticosteroids.
Term
Which anti-asthma drugs are not safe for pregnancy or breastfeeding?
Definition
Pretty much all are safe. Keep an eye on theophylline levels, ensuring that they are LLN. Avoid LTRAs in breastfeeding
Term
IgE-Neutralizing antibody

What is it?

Role in therapy?
Definition
Omalizumab

For patients with moderate to severe asthma who have had a positive skin test or in vitro reactivity to a perennial aeroallergen, whos symptoms are inadequately controlled with inhaled corticosteroids.
Term
Emergency treatment in asthma
Definition
O2 + Salbutamol + Ipratropium + parenteral corticosteroid
Term
Oral Corticosteroids

Place in therapy

Side effects
Definition
Oral Corticosteroids -

Place in therapy - preventing & treating acute exacerbations

Side effects - glucose intolerance, increased apetite, weight gain, mood alterations, fluid retention, & HTN. Long term: Diabetes, glaucoma, osteoporosis, Cataracts, myopathy
Term
What meds should be avoided in Asthmatics?
Definition
ASA & NSAIDs, Prefer selective BBs over non-selective
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