41. Asthma Flashcards
Common triggers of asthma
Pollution, cigarettes, cold air/changes in weather, pets, dusk, pollen, cockroaches, perfume/cosmetics
Drugs (Aspirin, NSAIDs, non-selective beta-blockers)
Comorbid conditions a/w asthma
Infections (cold/viruses), allergic rhinitis, GERD, obesity, obstructive sleep apnea, anxiety, stress, and depression
An asthma diagnosis is confirmed with ___
spirometry
FEV1 measures ___
how much air can be forcefully exhaled in one second
FVC measures ____
the max volume of air exhaled after taking a deep breath
FEV1/FVS measure ___
% of total air capacity (“vital capacity”) that can be forcefully exhaled in 1 second (speed of exhale)
Asthma diagnostic criteria
Measure baseline FEV1 with spirometry
Give albuterol
Measure post-bronchodilator FEV1
An FEV1 increase >12% post-bronchodilator is consistent with asthma diagnosis (considered “reversible”)
An FEV1 increase >___% post-bronchodilator (albuterol) is consistent with asthma diagnosis (considered “reversible”)
> 12%
What are the 2 major guidelines used for treating asthma?
Global Initiative for Asthma (GINA) - gold standard
NHLBI’s Expert Panel Report (EPR)
How frequent should follow up appointments be for asthma patients?
every 2-6 weeks after starting meds - ensure proper inhaler technique (priming, cleaning) and step up/down treatment
Decrease to 1-6 months once controlled
Vaccines recommended for asthma patients
Annual influenza
Pneumococcal vaccine
2 Primary rescue inhaler regiments
Combo of low-dose ICS + formoterol (preferred)
SABA in addition to ICS
In addition to treating acute asthma symptoms, relievers can be used preventively for ____
exercise-induced bronchospasm (EIB)
___ are the mainstay of maintenance treatment for asthma
ICS
How does combo med ICS + formoterol work as rescue asthma drug?
Formoterol = LABA with fast onset
Combination reduces the risk of exacerbations compared to SABA alone
How does SABA work as rescue asthma drug?
Quickly reverses bronchoconstriction
Note: SABAs do not treat underlying inflammation, should be used with an ICS (taken as needed at the same time as SABA or taken daily as maintenance med)
What is the role of systemic steroids in asthma?
Injections - used during exacerbations
Oral - used during exacerbations or severe asthma that is difficult to control with other drug combos
Note: use should be limited as much as possible d/t adverse effects
What is the role of inhaled epinephrine in asthma?
Not included in asthma guidelines
Available OTC, can be used intermittently for acute treatment for mild asthma only
What is the role of Inhaled short-acting muscarinic antagonists (SAMAs) (anticholinergics) in asthma?
Can be used in combo with SABA during exacerbations
What is the role of ICS in asthma?
First-line treatment for all pts; most effective anti-inflammatory drugs
What is the role of LABA in asthma?
Used in combo with ICS (should NEVER be used alone d/t risk of serious adverse outcomes)
Preferred add-on agents to ICS
What is the role of oral leukotriene receptor antagonist (LTRAs) in asthma?
Most commonly used in children
Alt option to LABA in combo with ICS; can also be added ICS/LABA treatment
What is the role of theophylline (PO or IV) in asthma?
Least desirable option for add-on treatment d/t significant adverse effects, drug interactions and the need to monitor serum drug concentrations
Requires monitoring serum drug conc!!
What is the role of LAMAs in asthma?
Can be used as add-on treatment in pts with hx of exacerbations despite ICS/LABA treatment