L16 Therapeutics of Asthma

Clinical practice guidelines, meta-analysis, and systematic reviews are the highest ranked forms of evidence.

Māori are 3.4 times, and Pacific peoples 3.9 times, more likely to be admitted to hospital with asthma than Europeans or other New Zealanders.

When diagnosing asthma there is no single “gold standard” test, and we must assess the pattern of [blank_start]signs and symptoms[blank_end](wheezing, breathlessness, chest tightness, and coughing, particularly at [blank_start]night[blank_end] or [blank_start]early[blank_end] in the morning). We can also measure [blank_start]expiratory airflow[blank_end] on more than one occasion, and assess [blank_start]response[blank_end] to inhaled bronchodilator +/- inhaled corticosteroid.

Ideal PEFR values depend on height and sex.

Which of these is NOT a principle of asthma treatment?

Goals of asthma treatment are about maintaining long-term control using the [blank_start]least[blank_end] amount of medications and [blank_start]minimising[blank_end] adverse effects. We want to prevent chronic [blank_start]symptoms[blank_end], require infrequent use ([blank_start]2[blank_end] or fewer days/week) of SABA, maintain normal or near-normal [blank_start]pulmonary[blank_end] function and maintain [blank_start]activity[blank_end] levels. We should assure patients’ and families’ [blank_start]satisfaction[blank_end] with asthma care. We also want to prevent exacerbations, the need for [blank_start]hospitalisation[blank_end], and prevent progressive [blank_start]loss[blank_end] of lung function.

Which of these is not a drug delivery device?

Treatment steps: 1. At initial diagnosis, all patients should use a [blank_start]SABA[blank_end], as required.. 2. Add an [blank_start]ICS[blank_end] if patients have symptoms for more than [blank_start]two[blank_end] weeks. Often a big decision! (The usual dose in adults is [blank_start]budesonide 400 mcg[blank_end]/day.) 3. If control is not adequate, [blank_start]ICS dose[blank_end] can be increased. 4. If control is not adequate, combine [blank_start]ICS with a LABA[blank_end]. ([blank_start]Formoterol+budesonide[blank_end] can be used as a preventer and replace SABA.) Patients can step up or down in order to achieve and maintain control. Check adherence and inhaler [blank_start]technique[blank_end] at each step of the way!