3: Adult Asthma Flashcards
Should you treat asthma during pregnancy?
Yes, beneficial outcomes for both mother and child. Asthma worsens for 1/3 and gets better for 1/3.
Should the PCP or OBGYN manage asthma during pregnancy?
PCP has better access to tools for treatment.
Most asthma medications are what pregnancy classification?
C
How do you manage an acute exacerbation?
- Rapidly establish severity.
- Concomitantly measure oxygen saturation; watch patient breathe; see if able to talk while breathing.
- Check for and correct hypoxemia while figuring out modality to open up lungs.
- Administer quick-relief medications.
- Administer oral steroids while waiting for the EMTs.
- Transferred to the hospital?
- Yes: Continue to monitor the patient upon discharge.
- No: Follow up within 2–7 days before treatment has been completed to assess success of treatment.
What exacerbations require steroids?
Moderate to severe.
Mild, moderate, severe, or life-threatening exacerbation?
- Dyspnea interferes with or limits usual activity
- Peak flow is 40–69% of predicted
- Relief from frequently inhaled SABA
- Treatment: oral corticosteroids
- Relief within 1-2 days
Moderate
When do you transfer a patient to the ER?
- Worsening respiratory distress
- Persistent distress
- Persistent hypoxemia
Mild, moderate, severe, or life-threatening exacerbation?
- Dyspnea with activity Pulmonary function is 70% of predicted
- Prompt relief with short-acting beta agonist (SABA)
Mild
What is the steroid dosing for adults outpatient?
- Prednisone/Prednisolone
- 1-2 mg/kg/day
- Max 40-80 mg/day
Mild, moderate, severe, or life-threatening exacerbation?
- Patient is unable to speak and perspiring.
- Peak flow is less than 25% of predicted.
- Patient is on continuous nebulizers and no relief from SABAs.
- Hospitalization is required, potentially in ICU.
- Treatment: Intravenous corticosteroids are a mainstay, while adjunctive therapies depend on what is popular.
Life-threatening
When is treatment failure considered in outpatient care?
If there are 3 back-to-back albuterol nebs or duo nebs without complete relief.
Mild, moderate, severe, or life-threatening exacerbation?
- Dyspnea at rest and difficulty with regular conversation
- Peak flow less than 40% of predicted or personal best
- Partial relief from frequently inhaled SABAs
- Never receive complete relief
- Treatment: oral corticosteroids or IV corticosteroids in the hospital
- Relief: symptoms persist for 3 days past the prescription
Severe (ER or hospitalize)
What is the preferred ICS in pregnancy?
Budesonide
What is the preferred SABA in pregnancy?
Albuterol
What is the preferred antihistamine in pregnancy if needed to control asthma and allergies or atopy together?
Loratidine or cetirizine (2nd gen)