Tuesday, 11 November 2014

Asthma - chronic treatment and management

GPs should be able to manage most asthma. The following points may be beneficial:

Steroids and "New" Drugs
Relvar Ellipta (GSK) is a dry powder inhaler that contains a corticosteroid (fluticasone furoate) and a long-acting beta2 agonist (vilanterol trifenatate). It is licensed for once-daily use as maintenance therapy for COPD and asthma.

Flixotide Evohaler is only available for the over 4s and Budesonide Easihaler only for those over 6. Seretide (fluticasone and serevent) is only for use in over 4s and Symbicort (budesonide and formoterol) only for the over 6s.

Methotrexate at low doses retains anti-inflammatory properties with little toxicity. In chronic severe asthma a number of mixed results have been reported with oral methotrexate.

Clinical issues
General questions, such as “how is your asthma today?” yield a non-specific answer; “I am ok”. Using closed questions, such as “do you use your blue inhaler every day?”, is likely to yield more useful information.
Education is a process and not a single event.
No patient should leave hospital without a written personalised asthma action plan.
Education should include personalised discussion of issues such as trigger avoidance and achieving a smoke-free environment to support people and their families living with asthma.
Brief simple education linked to patient goals is most likely to be acceptable to patients.
Do not recommend house dust mite avoidance to prevention asthma, or pet avoidance.


Treatment of reflux has no benefit in asthma control, although it does reduce dry cough.

Spacers
Single actuations of the metered dose inhaler into the spacer, each followed by inhalation.
Minimal delay between pMDI actuation and inhalation.
Tidal breathing is as effective as single breaths.
Spacers should be cleaned monthly rather than weekly as per manufacturer’s recommendations or performance is adversely affected. They should be washed in detergent and allowed to dry in air. The mouthpiece should be wiped clean of detergent before use.
Plastic spacers should be replaced at least every 12 months

References
http://bestbets.org/bets/bet.php?id=1768
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http://learning.bmj.com/learning/course-intro/asthmatic-patient.html?courseId=10046989&locale=en_GB = DONE
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http://r1.emsworld.com/files/cygnus/image/EMSR/2011/AUG/640x360/pocketguide_patient_10342321.jpg
http://learning.bmj.com/learning/module-intro/quick-tips-asthma.html?moduleId=10050019&searchTerm=%E2%80%9Casthma%E2%80%9D&page=1&locale=en_GB
http://learning.bmj.com/learning/module-intro/.html?moduleId=10051335&searchTerm=%E2%80%9Casthma%E2%80%9D&page=1&locale=en_GB
http://learning.bmj.com/learning/module-intro/occupational-asthma-evidence-based-diagnosis-management.html?moduleId=6051298&searchTerm=%E2%80%9Casthma%E2%80%9D&page=1&locale=en_GB
http://learning.bmj.com/learning/modules/flow/MCQ.html?execution=e9s1&moduleId=10029655&status=LIVE&action=start&_flowId=MCQ&sessionTimeoutInMin=90&locale=en_GB
http://www.enlightenme.org/knowledge-bank/cempaedia/asthma-adults
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http://learning.bmj.com/learning/course-intro/asthmatic%20patient.html?courseId=10046989&searchTerm=%E2%80%9Casthma%E2%80%9D&page=1&locale=en_GB
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http://www.enlightenme.org/knowledge-bank/cem-ctr/acute-asthma-does-addition-magnesium-sulphate-have-clinically-significant-eff
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http://calgaryguide.ucalgary.ca/slide.aspx?slide=Asthma%20-%20Findings%20on%20Investigations.jpg
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http://calgaryguide.ucalgary.ca/slide.aspx?slide=Asthma%20-%20Pathogenesis.jpg
https://www.brit-thoracic.org.uk/document-library/clinical-information/asthma/btssign-asthma-guideline-2014/
https://www.brit-thoracic.org.uk/document-library/clinical-information/asthma/btssign-asthma-guideline-quick-reference-guide-2014/


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