Asthma Management (Respiratory Medicine)

ASTHMA CASE STUDY
CONTINUOUS MEDICAL EDUCATION

1. MO CASE DISCUSSION BY: RAJHMUNIRAN KANDASAMY

2. ASTHMA MANAGEMENT

3. ASSESSMENT OF BRONCHIAL ASTHMA SYMPTOM CONTROL RISK OF ADVERSE OUTCOME

4. SYMPTOM CONTROL

5. RISK OF ADVERSE OUTCOME

6. UPDATES IN GINA 2024

7. TERMINOLOGY OF ASTHMA MEDICATION CONTROLLER MAINTAINANCE TREATMENT MAINTANANCE-AND-RELIEVER THERAPY RELIEVER

8. TERMINOLOGY AIR

9. GINA 2024 Box 1-1

10. DIAGNOSIS Presence of typical variable symptoms of asthma OR Documented variable expiratory airflow limitation on spirometry

11. OTHER GINA UPDATES Cough variant asthma – spirometry maybe normal, diagnosed with bronchial provocation test , treat as for asthma, with inhaled ICS Montelukast (LTRA) –potential neuropsychiatric effects Pulmonary rehabilitation for asthma – Systematic review demonstrated benefit of functional exercise capacity and quality of life in people with asthma Home nebulization of SABA is not recommended as can increase risk of severe exacerbations/risk of asthma mortality/ risk of transmission of infection. Oral bronchodilators are NOT recommended- global access to inhaled medicines Salbutamol tablets/oral theophylline Slow onset / less effective for sx relief compared to inhaled bronchodilators Do no treat airway inflammation that is characteristics of asthma

12. REVIEW OF RESPONSES AND ADJUSTMENT OF TREATMENT Inc 1-2 weeks of ICS during viral infx STEP UP SHORT TERM STEP DOWN STEP UP Good asthma control with stable lung function over 3 months STEP DOWN LONG TERM Inc ICS for 2-3 months despite good adherence, tech but uncontrolled sx Review after 2-3 months

13. TIOTROPIUM BROMIDE 2.5MCG/PUFF INHALATION GENERIC NAME TIOTROPIUM 2.5MCG/PUFF SOLUTION FOR INHALATION DESCRIPTION: Clear, colourless solution filled into a 4.5ml cartridge. The solution is to be used with a Respimat Inhaler BRAND: SPIRIVA RESPIMAT CATEGORY: A/KK QUOTA ITEM: YES

14. APPROACH ON PATIENT WITH DIFFICULT TO CONTROL ASTHMA History and physical examination are IMPORTANT INCORRECT DIAGNOSIS Asthma education NON COMPLIANCE / POOR TECHNIQUE Possible of obesity, GERD,allergic rhinits UNRECOGNISED AGGRAVATING COMORBIDITIES Controlled can only be maintained with intensive therapy SEVERE ASTHMA Explore the possibility Skin prick test CONTINUING EXPOSURE TO SENSITISING AGENTS

15. MANAGEMENT OF ASTHMA EXACERBATION IN PRIMARY CARE

16. ASTHMA IN CHILDREN

17. All children experiencing wheezing episodes should be provided with inhaled SABA for relief of symptoms, although is not effective in children. If child uses SABA for the relief of sx on average of more than > 2x/ week over 1 month , indicates the need of trial of low dose ICS . Initial episodes of wheeze in children < 1 year often occur in setting of infectious bronchiolitis, thus SABA are generally ineffective for bronchiolitis.

18. INITIAL ASSESSMENT OF ACUTE ASTHMA EXACERBATION IN 5 YEARS AND YOUNGER

19. MANAGEMENT OF ACUTE EXACERBATION

20. DELIVERY OF SABA PMDI AND SPACER NEBULIZER VS.

21. WRITTEN ASTHMA ACTION PLAN Helps patient to recognize and respond appropriately to worsening of asthma

22. THANK YOU FOR YOUR ATTENTION!!

23. AUDIT CLINICAL ASTMA (ACA)