7. Asthma Flashcards
Describe : History of variable respiratory symptoms of asthma (4)
- Generally more than one respiratory symptom (wheeze, dyspnea, cough, chest tightness)
- Worse at night or early morning (on waking)
- Symptoms vary over time and in intensity
- Triggered by endogenous/exogenous stimuli (exercise, laughter, allergens, changes in weather, irritants - eg. car fumes, viral infections)
Describe FEV1/FVC in asthma
<0.75-0.8 in adults and <0.9 for children
Describe : Post-bronchodilator reversiblity
increase in FEV1 >12% (minimum of 200mL in adults)
Describe symptom control questionnaire for asthma
Describe : Future risk of adverse outcomes (independent of symptom control) for asthma (6)
- History of ≥ 1 exacerbation in previous year
- Poor adherence
- Incorrect inhaler technique
- Low lung function (Measure lung function at 0, 3-6 months, then periodically)
- Smoking
- Blood eosinophilia
Recommendations for initial controller therapy : If symptoms <2/month and no risk factors
Consider no controller
Recommendations for initial controller therapy : If symptoms >2/month or risk factors
Consider Low-dose ICS
Recommendations for initial controller therapy : If symptoms >2/week
Low-dose ICS
Recommendations for initial controller therapy : Asthma most days or waking due to asthma ≥1/week
Medium/high-dose ICS or Low dose ICS/LABA
Recommendations for initial controller therapy : Severely uncontrolled asthma or acute exacerbation
Short course oral corticosteroids AND High-dose ICS or Moderate-dose ICS/LABA
Describe : Follow-up in asthma
Ideally 1-3 months after starting treatment, and q3-12 months after
Step-up vs. Step-down
Describe patient education : Asthma (11)
- Smoking cessation
- Healthy diet
- Weight reduction
- Breathing exercises
- Dealing with emotional stress
- Swimming in young people with asthma
- Vaccinations (influenza)
- Avoid indoor/outdoor allergens
- Avoid occupational exposures/allergens
- Caution with medications that could worsen asthma (NSAIDs, BB)
- Consider vaccinations (no good evidence)
Consider referral in asthma if (5)
- Difficult confirming diagnosis
- Occupational asthma
- Uncontrolled asthma
- Risk factors for asthma-related death (ICU admission, anaphylaxis or confirmed food allergy)
- Treatment side effects
Describe : Hospital Management of asthma exacerbation
Initial assessment (ABC, life threatening signs)
Assess severity based on dyspnea, RR, HR, O2 sat, Lung function (or PRAM score)
* Mild-moderate : Talks in phrases, not agitated, Pulse 100-120, O2>90%
* Severe : Talks in words, agitated, RR>30/min, Accessory muscle use, Pulse >120bpm, O2 <90%
Oxygen (Target 93-95%)
SABA MDI with spacer 4-8 puffs or 5mg nebulizer q20 mins x 3 (for one hour)
* Then depending on severity, SABA 4-8 puffs q1-4 hours
* No additional SABA if Peak Flow Measurement >60-80% of predicted or personal best x4 hours
* New spacer should be washed or primed with 20 puffs of salbutamol (because of static charge)
Early oral corticosteroids
* Methylprednisolone 40mg IV q12h (1-2mg/kg/day divided BID) until improved
* Prednisone 40-60mg daily (1-2mg/kg/day divided BID) x 3-10d
* Dexamethasone 12-16mg daily (0.6mg/kg/day) for 1-2 doses. Consider longer 5-10 days depending on severity, taper glucocorticoids if >10d course
Measure lung function after one hour of treatment
* PEF<60% of predicted or best, or clinically not improved -> SEVERE -> Continue treatment and reassess
* PEF 60-80% of predicted or best -> MODERATE -> Consider Discharge
