Asthma

Question 1

what are controller medications

Answer 1

• taken daily on a long-term basis
• ics: primary controller
• long acting inhaled beta 2 agonists (laba)
• laba + ics

Question 2

examples of laba + ics

Answer 2

fluticasone + salmeterol
budesonide + formoterol
fluticasone + formoterol
fluticaonse + vilanterol

Question 3

what are reliever medications

Answer 3

• as needed basis

- rapid acting inhaled b2 agonists (saba), sama, methylxanthine

Question 4

what is smart therapy

Answer 4

• single inhaler maintenance and relief therapy
• formoterol and budesonide for rescue and maintenance
• reduced exacerbations
• improvements in asthma control

Question 5

criteria for diagnosing asthma

Answer 5

• variability: episodic, precipitation by allergens, nocturnal worsening of symptoms
• response to appropriate asthma therapy
• family history

Question 6

levels of asthma control

Answer 6

• controlled
• partly controlled
• uncontrolled

factors: daytime symptoms, limitations in activities, nocturnal symptoms, need for rescue treatment, lung function, exacerbation

Question 7

gina guidelines for initial control

Answer 7

<2x/mo = as needed low dose ics-formoterol

> 2x/mo = daily low dose ics or as needed low dose ics-formoterol

most days, waking 1x/wk = low dose ics-laba

most days, waking >1x/wk = medium dose ics-laba

more symptomatic and uncontrolled than step 4 = high dose ics-laba

Question 8

gina initiative for asthma

Answer 8

• assess: diagnosis, risk factors, comorbids, technique and adherence!!, preferences and goals
• adjust
• review response

Question 9

preferred reliever for steps 1-5

Answer 9

low dose ics-formoterol, as needed

Question 10

gina no longer recommends ____ treatment for step 1

Answer 10

saba-only: increases risk for severe exacerbations

Question 11

t/f episodes of high reliever use (>6 inhalations/day on at least one day) dont predict mortality and risk for exacerbations

Answer 11

false!! they predict these outcomes

Question 12

what is mild asthma

Answer 12

• symptoms of less than weekly for the previous 3 months

Question 13

what is an exacervation

Answer 13

progressive worsening of shortness of breath, cough, wheezing, or chest tightness, or a combination

Question 14

_____ are better indicators for severity of airflow obstruction than degree of symptoms

Answer 14

significant decreases in pef or fev1

Question 15

therapies for exacerbations

Answer 15

• repetitive rapid acting inhaled b2 agonist (saba)
• early systemic glucocorticoids (hydrocortisone, prednisone)
• o2 supp

Question 16

commonly used glucocorticoids

Answer 16

• dexamethasone (iv and oral)
• hydrocortisone (iv)
• methylprednisolone
• prednisone