asthma + COPD

Question 1

what should be monitored if a patient taking a SABA (e.g salbutamol, terbutaline), has severe asthma

Answer 1

plasma-potassium concentration as there is a risk of hypokalemia

Question 2

what is the interaction between Sotalol and Salmeterol/Salbutamol

Answer 2

severe interaction which causes hypokalemia which increases risk of torsades de pointes

Question 3

how should a spacer be cleaned

Answer 3

• should be cleaned once a month by washing in mild detergent and then allowed to dry in air without rinsing
• the mouthpiece should be wiped clean of detergent before use
• note: Some manufacturers recommend more frequent cleaning, but this should be avoided since any electrostatic charge may affect drug delivery. Spacer devices should be replaced every 6–12 months*

Question 4

describe the step by step for asthma management based on NICE guidelines

Answer 4

step 1: short acting beta-2 antagonist SABA (e.g salbutamol or terbutaline)

step 2: low dose inhaled corticosteroid ICS e.g (beclomethasone, fluticasone, mometasone, budesonide)

step 3: leukotriene receptor antagonist (LTRA) (e.g montelukast)

step 4: add a LABA (still taking ICS). +/- LTRA. If asthma remains uncontrolled, offer to change the ICS + LABA maintenance therapy to a MART regimen, with a low-dose of ICS as maintenance.

step 5: increase ICS dose or add theophylline/LAMA

• LABA = long-acting bronchodilator. e.g Serevent (salmeterol), Foradil (formoterol), theophylline (is a tablet form)

LAMA= long acting muscranic antagonist
e.g aclidinium (Genuair), 
glycopyrronium (Breezhaler), 
tiotropium (HandiHaler, Respimat), 
umeclidinium (Ellipta)*

Question 5

describe the step by step asthma management based on BTS/SIGN guidelines

Answer 5

step 1: short acting beta-2 antagonist SABA (e.g salbutamol)

step 2: low dose inhaled corticosteroid ICS e.g (beclomethasone, fluticasone, and mometasone)

step 3: long acting beta-2 antagonist LABA. This can be given as either a fixed-dose ICS and LABA regimen, or a MART regimen

step 4: increase ICS dose or add leukotriene receptor antagonist (LTRA) (e.g montelukast) or Theophylline

step 5: oral corticosteroid e.g prednisolone

*note: LABA e.g Serevent (salmeterol), Foradil (formoterol), theophylline (is a tablet form) *

Question 6

what is the MART regimen in asthma

Answer 6

Maintenance And Reliever Therapy—a combination of an ICS and a fast-acting LABA such as formoterol in a single inhaler e.g beclometasone with formoterol, budesonide with formoterol

note: this is the 3rd step in the BTSs/sign 2019 guidance if low dose ICS + SABA is not effective

Question 7

TRUE OR FALSE

all patients who have had an asthma attack (acute asthma) should be prescribed a course of oral prednisolone

Answer 7

true

note: Continue usual inhaled corticosteroid use during oral corticosteroid treatment. if oral prednisolone can’t be taken, can give by I.V, I.M

Question 8

what is the only contraindication for carbocisteine

Answer 8

active peptic ulcer

Question 9

describe the technique for using an inhaler

Answer 9

Form a tight seal around the mouthpiece with their lips, then breathe in quickly and deeply

Question 10

what advice can you give to a patient to manage an asthma attack

Answer 10

• Take one puff of your reliever inhaler (salbutamol) every 30-60 seconds up to 10 puffs.
• If you feel worse at any point OR you don’t feel better after 10 puffs call 999 for an ambulance.

Question 11

what is the first line treatment for an asthma attack (acute asthma)

Answer 11

a high-dose inhaled short-acting beta2 agonist (such as salbutamol) given as soon as possible

note: In all cases of acute asthma, patients should be prescribed an adequate dose of oral prednisolone. Continue usual inhaled corticosteroid use during oral corticosteroid treatment

Question 12

can you use a spacer with a dry powder inhaler

Answer 12

no- spacers should only be used with metered-dose inhaler.

note: Spacer devices should not be regarded as interchangeable; patients should be advised not to switch between spacer devices

Question 13

what are the first choice antibiotics used in an infective exacerbation of COPD

Answer 13

amoxicillin, doxycycline or clarithromycin.