Asthma Flashcards
An asthma diagnosis is confirmed with _______ and pulmonary function tests
spirometry
How do you know if someone’s asthma is reversible?
when a patient tests their baseline, and then tests for reversibility by using a short acting dilator - if the FEV1 increases by more than 12% with the use of a bronchodilator
FEV1, FVC, or FEV1/FVC
How much air can be forcefully exhaled in one second
FEV1
FEV1, FVC, or FEV1/FVC
After taking a deep breath, the maximum volume of air that is exhaled (how much air is exhaled)
FVC
FEV1, FVC, or FEV1/FVC
The percentage of total air capacity (“Vital capacity”) that can be forcefully exhaled in one second (the speed of the exhale)
FEV1/FVC
What classification of asthma?
Daytime symptoms <2days/week
SABA rescue inhaler use <2 days/week
intermittent
What classification of asthma?
Daytime symptoms >2 days/week but not daily
SABA rescue inhaler use >2 days/week but not daily or >1x/day
mild
What classification of asthma?
Daytime symptoms daily
SABA rescue inhaler use daily
moderate
What classification of asthma?
Daytime symptoms - throughout the day
SABA rescue inhaler use - several times per day
severe
What do you do at each visit with the patient?
confirm appropriate inhaler technique
technique, priming, and cleaning
review asthma action plan
assess, step up, maintain, or step down treatment
What vaccines are recommended in patient with asthma?
annual influenza vaccine
age 2-62 = Pneumavax 23
*Prevnar 13 only if the child is not between the age of 6-18 years who require high dose oral steroids
When is it considered “frequent” use of an inhaler and know its time to reassess asthma control
using SABA >2x/week
If an ICS + formeterol is used as the rescue inhaler, worsening asthma control is indicated by the frequency of symptoms
What is the mainstay of treatment in asthma?
ICS!!!
doses are categorized as low medium or high
What rescue drug?
used as needed for acute asthma symptoms
combination proven to have reduced exacerbations over SABA alone
inhaled low dose ICS+formeterol
What rescue drug?
used as needed for acute asthma symptoms
quick reverse bronchoconstriction
inhaled SABA
What rescue drug?
ORAL, used during exacerbations or for severe asthma
systemic steroids
What is the first line maintenance drug in presistent asthma?
inhaled corticosteroids
What maintenance drug?
used in combination with ICS (should NEVER be used alone)
preferred added on agents to ICS
inhaled LABAs
What maintenance drug?
most commonly used in children
alternative option to LABA in combination to ICS, can also be added to ICS/LABA
oral leukotriene receptors antagonists (LTRAs)
What maintenance drug?
LEAST desirable add on treatment due to significant adverse effects – monitor serum drug concentrations
theophylline for oral or IV
What maintenance drug?
can be used as add on treatment in patients with a history of exacerbations despite ICS/LABA treatment
LAMA
aka inhaled anticholinergics
What is the name of the maintenance drug that is an injectable MAb? (SC or IV)
omalizumab for severe allergic asthma
STEP 1 of the treatment step based on asthma severity
patient has intermittent asthma - what is prescribed?
as needed low-dose ICS + formeterol
OR
low dose ICS taken whenever SABA is taken
STEP 2 of the treatment step based on asthma severity
patient has mild asthma - what is prescribed/changed?
from step 1: ADD AN ICS CONTROLLER —-
Daily low dose ICS
or
as needed low dose ICS + formeterol (used as the reliever if that combination is also used for maintenance. if a different LABA is used for maintenance, then a SABA would be used as the reliever)
STEP 3 of the treatment step based on asthma severity
patient has moderate asthma - what is prescribed/changed?
from step 2: ADD A LABA OR DAILY DOSING
Low dose ICS + LABA (used as the reliever if that combination is also used for maintenance. if a different LABA is used for maintenance, then a SABA would be used as the reliever)
STEP 4 of the treatment step based on asthma severity
patient has severe asthma - what is prescribed/changed?
from step 3: INCREASE ICS DOSE
medium dose ICS + LABA
a patient is still having considerable symptoms after completing step 4. what do you do?
INCREASE ICS DOSE
high dose ICS+LABA, refer for further assessment
______ are used as part of maintenance therapy beginning in stem 3 of treatment and only in combination with an ICS
LABA
What are some SABAs?
albuterol (ProAir HFA, ProAir RespiClick, Prevonteil HDA, Ventolin HFA) 90mcg/inh
Levalbuterol (Xopenex)
*racepinephrine should not be used because it is non-selective
What is the dosing for albuterol?
MDI/DPI: 1-2 inhalations every 4-6 hours as needed
What common side effects of SABAs?
nervousness
tremor
tachycardia
palpitations
cough
hyperglycemia
LOW POTASSIUM
Most albuterol inhalers contain 200inh/canister, the exception is ____________ which is available as both 200 and 60inh/canister
Ventolin HFA
For EIB, use 2 inhalations ____ mins prior to exercise
5 minutes
Salmeterol (Serevent Diskus)
LABA
*also used in COPD
Brand: QVAR redihaler
generic: beclomethasone
Brand: Pulmicort Flexhaler
generic: budesonide