List 3 drug-drug interactions in asthma/COPD
- Patients already on theophylline - careful with aminophylline infusions
Drugs that lower potassium
Theophylline interactions - e.g. lithium, macrolides
What are drug-disease interactions?
Diseases that may be affected by drugs used in asthma/COPD
- Or disease that may affect the drugs
List 3 drug-disease interactions in asthma/COPD
Cardiovascular disease (watch potassium)
List 8 symptoms of acute asthma
- Severe breathlessness
Tachypnea - abnormally rapid breathing
Tachycardia - abnormally rapid heart rate
Silent chest - lungs tighten so much during attack that there is not enough air movement for wheezing
Cyanosis - blue-ish skin due to poor circulation/inadequate oxygenation of the blood
Accessory muscle use - muscles that assist but do not play primary role in breathing
- Altered consciousness
- Decreased oxygen saturations
How does oxygen relieve the symptoms of a severe asthma attack?
Cells have been starved of oxygen during attack = hypoxia and possibly cyanosis
SpO2 level of 94-98%
How do B2 agonist bronchodilators relieve the symptoms of a severe asthma attack?
- Relieve bronchospasm
- Repeat at 15-30 minute intervals
- Can be given via nebuliser or IV
How do steroids relieve the symptoms of a severe asthma attack?
Prednisolone 40-50mg for at least 5 days
Reduces mortality, relapses, subsequent admission and requirement for B2 agonist therapy
- Can be given orally or parenterally
- Earlier the steroids are given, the better the outcome
How does ipratropium bromide (Atrovent) relieve the symptoms of a severe asthma attack?
Greater bronchodilation than a B2 agonist alone
- Leads to faster recovery and shorter duration of admission
How does magnesium sulphate relieve the symptoms of a severe asthma attack?
- IV or nebuliser 1.2g-2g
- IV infusion over 20 minutes
How does aminophylline relieve the symptoms of a severe asthma attack?
- For patients with near-fatal/life-threatening asthma who have poor response to initial therapy
- Given via IV
- Check levels if taking oral theophylline
List 6 things that should be monitored in an asthma patient
PEFR - peak expiratory flow rate - tests lung function
- Oxygen saturation
- Heart rate
- Blood glucose
- Serum theophylline
What should occur post-hospital admission following an asthma attack?
- Patient should be followed-up and reviewed as soon as possible by their asthma nurse
Asthma action plan (PAAP) written/reviewed
What 3 things should occur during counselling of asthma patients?
Assess the exacerbation = trigger factors
Optimise treatment - compliance, review inhaler technique, consider stepping-up treatment
Review understanding - of how to recognise exacerbation and what to do
List the 3 steps of the controlling of symptoms of asthma
- Step 1: Inhaled short-acting B2 agonists e.g. salbutamol, terbutaline
- Step 2: ICS e.g. beclometasone, fluticasone
- Step 3: LABA, leukotriene receptor antagonist or theophylline and using a daily corticosteroid tablet
List 2 side effects of ICSs
- Oral candidiasis
Dysphonia - difficulty in speaking
Higher doses = more severe side effects
List 3 side effects of LABAs
- Cardiovascular stimulation
List 4 side effects of leukotriene receptor antagonists
- Abdominal pain
- Sleep disturbances
What advice should be given to patients taking ICSs
- Prolonged high-dose ICS use = risk of systematic side effects
Visit GP if experience: worsening fatigue, muscle weakness, loss of appetite
Reduce dose gradually
- Carry steroid card as appropriate
List 5 counselling points for asthmatics
- Know the difference between a preventer and a reliever
- Understand the importance of using their preventer inhaler regularly, even when they are well
- Know when their inhaler needs to be changed and how to replace it
- Don't waste their medicines through inappropriate usage e.g. test pressing
Clean their spacer correctly and often
List 3 ways to improve medicines optimisation
Spacer compatible with device
- Ensure patient understands the "relapsing remitting" nature of asthma
- Make sure patient understands their PAAP
What does COPD stand for?
Chronic obstructive pulmonary disease
What is the purpose of most treatments for COPD?
To control or reduce the rate of exacerbation (worsening)
What lifestyle change has been the only factor to have slowed the decline in lung function from COPD?
How do mucolytics work?
Increase expectoration (coughing) of sputum by decreasing its viscosity
Discontinue if no improvement after 4 weeks
Give an example of a mucolytic and its dose
1.5g-2.25g daily in divided doses
List 2 new treatments in COPD
- Combination of long-acting muscarinic antagonist and long-acting B2 agonist
Describe the use of LAMA and LABA combined to treat COPD
- Used if ICS/LABA is not tolerated
Once or twice daily administration, depending on product
Convenience and less expensive as one inhaler
Describe the use of Roflumilast
- Phosphodiesterase type-4 inhaler
- Adjunct to bronchodilators for maintenance treatment
- Causes weight loss - patients should monitor body weight
List 5 things that should be monitored in COPD
- Oxygen saturations
FEV1 = volume of air that can be expelled from maximum inspiration in the 1st second
- Exercise tolerance
- Frequency of exacerbations (episodes)
List 3 ways to improve medicines optimisation in COPD treatment