Asthma Patient Assessment Quiz

Asthma Control

• Check patient's asthma control by assessing symptoms, medication use, and lung function
• Check if patient has been prescribed preventers and is adherent to medication
• Check level of SABA usage and patient's technique for using SABA inhaler
• Check for comorbid conditions (AR, OSA, GORD) and refer if needed
• Check if patient has an asthma action plan

Asthma Management

• Provide Reliver PuEer and demonstrate proper technique
• Provide Bisolvon Dry Cough Liquid if necessary
• Educate patient on preventer use and asthma management
• Raise awareness about serious asthma flare-ups and asthma first aid
• Suggest keeping a symptom diary for GP visits
• Provide information on asthma management (Asthma Australia) and record key counseling

Asthma Trajectories

• Variable pathways: early onset (atopic), post-puberty resolution/new development, adult onset (late onset asthma)
• Importance of understanding trajectories to answer patient questions about growing out of asthma

Respiratory Tract

• Inspiration: contraction of diaphragm and external intercostal muscles increase thoracic cavity space and decrease intra-pleural pressure
• Expiration: relaxation of diaphragm and increase in intra-pleural pressure
• Inspiration-expiration cycle allows for gas exchange

Respiration Control

• Managed by CNS respiratory control system
• Central neural respiratory generator
• Sensory input system (thoracic neural receptors, peripheral and central medullary chemoreceptors)
• Muscular effector system

Asthma Pathogenesis and Pathophysiology

• Asthma is a chronic obstructive lung disease that can be controlled but not cured
• Characterized by respiratory symptoms (cough, wheeze, dyspnoea, or chest tightness) and excessive variation in expiratory airflow function
• Associated with airway inflammation and airway hyper-responsiveness

Risk Factors for Asthma

• House dust mites
• Mould
• Pets
• Pollen
• Cigarette smoke
• Exercise
• Smoke
• Chemicals
• Stress
• Emotions
• Hormonal changes (women)
• Respiratory infections (common cold = 80% of bad asthma exacerbations)
• Weather (e.g. thunderstorms)
• Medications
• Occupational exposures

Asthma Pathophysiology

• Repeated infections/exposures disrupt airway epithelial barrier leading to danger signaling and chemokine secretion
• Immature dendritic cells (DC) act as antigen-presenting cells (APCs)
• Allergen-linked APCs stimulate naïve T helper cells to differentiate to Th2 cells
• Cytokines linked to Th2 cell response drive inflammation (majority of asthma cases) - eosinophils are the main driver

Counselling on Controlling Asthma

• Educate patients on controlling asthma to reduce lung remodeling
• Importance of preventers in asthma management

Asthma Diagnosis

• History (family, symptoms, pattern)
• Physical examination (wheeze)
• Consideration of other diagnoses
• Documenting variable airflow limitation (spirometry)

Assessing Asthma Control

• Risk factors for asthma flare-ups

Asthma Treatment Principles

• Bronchodilators (relievers): SABAs, LABAs, SAMAs/LAMAs
• Anti-inflammatory agents (preventers): ICS, LTRAs, targeted biologic agents
• Need for preventers if symptoms occur more than twice a month
• Most children can be treated with SABA alone or with ICS or montelukast additions
• No ICS+LABA combination allowed for 1-5 years children

Reliever Medications - Schedule 3

• Short-acting beta agonists (SABAs): salbutamol and terbutaline
• Salbutamol: formulation type, strength, time to action, elimination half-life, dose, precautions, side effects
• Terbutaline: formulation type, strength, time to action, elimination half-life, dose, precautions, side effects

Dry Powder Inhalers - Turbuhalers

• Teach back method: key steps

Key Roles for Pharmacists

• Educate patients on proper inhaler use
• Counsel patients on asthma management and control
• Monitor patient adherence to medication and asthma control
• Identify and address SABA use issues