Lqts Patient with a Diagnosis of Asthma

LQTS PATIENT WITH A DIAGNOSIS OF ASTHMA

S. Collins et al. / Paediatric Respiratory Reviews 13 (2012) 100–10

Once a diagnosis of asthma has been made in these patients,

careful assessment of the severity of symptoms should be made.

These patients should already be on a ß-blocker as part of their

LQTS treatment.

 Consideration should be given to use of ipratropium bromide as a

reliever medication. If this is ineffective, beta-agonist reliever

should be added.

******

 If symptoms are severe enough to require a preventer medication

then consider starting a leukotriene antagonist as first line. The

aim here would be to avoid the potential corticosteroid related

increase in cardiac event risk.

****

 Failure to achieve control on a leukotriene anatagonist could lead

to addition of low-dose inhaled corticosteroids.

****

Patients who still require regular doses of an inhaled ß-agonist

and/or those who have frequent exacerbations should be managed

in liaison with a Cardiologist in order to consider further

prophylactic treatment such as left sympathetic denervation or

implantable cardiac defribrillator (ICD).

This approach can also be modified according to LQTS genotype

as ß-agonists are likely to be relatively safe in LQT3, and it may be

more appropriate to take a more standard approach to asthma

management in these patients.

ASTHMA PATIENTS WHO RECEIVE A DIAGNOSIS OF LQTS

A difficulty may arise if a patient with well controlled asthma is

diagnosed with LQTS. LQT3 patients are unlikely to need any

change to their ß-agonist therapy; however the current recom-

mendations are for all LQTS patients to be started on ß-blockers

regardless of genotype.An assessment by a respiratory physician

is advisable, as this would be an excellent opportunity to rationalise

the patient’s asthma medications. An approach similar to that in

new diagnosis of asthma, as described above, could then be

adopted. The addition of ipratropium bromide as a reliever could

help to reduce the need for ß-agonist therapy. Close monitoring of

symptoms following commencement of ß-blockers is suggested.

FAMILY MEMBERS OF THOSE WITH LQTS

In family members of those who have LQTS, all potentially

afflicted members are screened with ECG and potentially exercise

testing and genotyping prior to genetic counselling. This process

should allow clinicians to differentiate those who should be

treated as having LQTS and those who can follow standard asthma

management guidelines.

ACUTE, SEVERE EXACERBATIONS OF ASTHMA IN LQTS PATIENTS

Management of these situations involves a balance of risks. The

effects of a cardiac event in LQTS are potentially serious and

treatment should aim to minimise this risk, however, this must be

balanced against the need to appropriately treat a severe asthma

exacerbation. It is importantto consider that an acute exacerbation

of asthma may cause a significant tachycardia and that successful