Asthma

Question 1

Severity Classification & Treatment Steps

Answer 1

[Rescue Inhaler Use]

Intermittent:
[Step 1] ≤ 2 days/week

Persistent:
[Step 2] Mild > 2 days/week
[Step 3] Moderate DAILY
[Step 4/5] Several Times per Day

Question 2

Treatment considerations

Answer 2

LABA is NEVER used monotherapy

Spiriva Respimat is the ONLY LAMA used in asthma (adjunct therapy)

NO LABA-LAMA combos
NO ICS-LABA-LAMA combos

Question 3

Reliever Tx

Answer 3

ICS-formoterol

ICS + SABA

Question 4

Treatment Algorithm Step 1

Answer 4

Intermittent: Rescue Inhaler Use ≤ 2 days/week

[PRN Reliever Inhalers]

1) Low Dose ICS + Formoterol (PRN)
2) ICS + SABA (PRN)

Question 5

Treatment Algorithm Step 2

Answer 5

Mild Persistent: Rescue Inhaler Use > 2 days/week, but less than Daily

1) Low Dose ICS (DAILY)
2) Low Dose ICS + Formoterol (PRN)

Question 6

Treatment Algorithm Step 3

Answer 6

Moderate Persistent: Rescue Inhaler Use = DAILY

[Add LABA]
1) Low Dose ICS + LABA (DAILY)

Question 7

Treatment Algorithm Step 4

Answer 7

Severe Persistent: Recue Inhaler Use = Multiple Times/Day

1) Med Dose ICS + LABA (DAILY)

Question 8

Treatment Algorithm Step 5

Answer 8

Severe Persistent: Recue Inhaler Use = Multiple Times/Day

1) High Dose ICS + LABA (DAILY)

Question 9

Asthma ICS Drugs (Generics)

Answer 9

If you see ICS monotherapy = asthma

1) Beclomethasone
2) Budesonide
3) Fluticasone

Question 10

ICS Brands:
Beclomethasone
Budesonide
Fluticasone

Answer 10

1) Beclomethasone = QVAR Redihaler
2) Budesonide = Pulmicort
3) Fluticasone = Flovent / Arnuity Ellipta

Question 11

Asthma LABA (single component inhaler)

Answer 11

Add On, NEVER MONOTHERAPY:

Salmeterol (Severent Diskus)

Question 12

Asthma LAMA (single component inhaler)

Answer 12

Add On, NEVER MONOTHERAPY:

Tiotropium (Spiriva RESPIMAT)

Question 13

ICS + LABA Drugs (Generics)

Answer 13

1) Budesonide-Formoterol
2) Mometasone-Formoterol
3) Fluticasone-Salmeterol
4) Fluticasone-Vilanterol

Question 14

ICS + LABA Drugs (Brands)

1) Budesonide-Formoterol
2) Mometasone-Formoterol
3) Fluticasone-Salmeterol
4) Fluticasone-Vilanterol

Answer 14

1) Budesonide-Formoterol = Symbicort
2) Mometasone-Formoterol = Dulera
3) Fluticasone-Salmeterol = Advair / AirDuo
4) Fluticasone-Vilanterol = Breo Ellipta

Question 15

Which ICS + LABA used for RESCUE?

Answer 15

OK for Rescue b/c contain Formoterol

1) Budesonide-Formoterol = Symbicort
2) Mometasone-Formoterol = Dulera

AVOID for Rescue:

1) Fluticasone-Salmeterol = Advair / AirDuo
2) Fluticasone-Vilanterol = Breo Ellipta

Question 16

MDI (Metered Dose Inhaler) considerations

Answer 16

Liquid = HFA, Respimat, QVAR Redihaler, No Suffix

Slow, Deep Inhalation
OK with Spacer
Shake (EXCEPT: Respimat, QVAR Redihaler, Alvesco)

Question 17

DPI (Dry Powder Inhaler) considerations

Answer 17

Powder = Diskus, Ellipta, Pressair, Handihaler, Neohaler, Flexhaler, RespiClick

Fast, Deep Inhalation
Do NOT use spacer
Do NOT shake

Question 18

Theophylline considerations

Answer 18

Dosed with IBW

Therapeutic Range: 5 - 15 mcg/mL

Conversion:
Aminophylline to Theophylline (ATM) = multiply
Aminophylline x 0.8 = Theophylline

Question 19

Omalizumab

Answer 19

[Xolair] SQ every 2-4 weeks
Indication = Allergic Asthma @ blocks IgE receptors

BBW = anaphylaxis; must be administered in healthcare setting

Question 20

IL-antagonist mAbs

Answer 20

Indication = Eosinophilic Phenotype

Dupilimumab (Dupixent) & others

Question 21

Asthma in Pregnancy

Answer 21

Requires Reliever:

Preferred ICS = budesonide

Question 22

RespiClick consideration

Answer 22

[DPI]

Opening will load a dose

Question 23

Asthma Diagnosis

Answer 23

FEV1 > 12% improvement after SABA

Question 24

Asthma Vaccines

Answer 24

Influenza

PPSV 23 now, then PPSV > 65 years