Asthma Flashcards
Risk Factors
- Positive family history
- Concurrent atopy!*
Predisposition for increased production of immunoglobulin E (IgE) after exposure to common allergens
One of strongest predisposing factor in the development of asthma - Smoking + secondhand smoke
- Higher BMI
- Severe viral respiratory infections during first 3 years of life
Triggers
- Inflammatory: allergens, respiratory infections, work
- Irritants: temperature change, exercise, strong odors, stress/emotions, cold air
- Other: medication, tabacco, gastric reflux, pollutants, food additives
Symptoms
- Intermittent episodes of wheezing, coughing, and dyspnea (esp. at night / early morning)
- Some patients experience chest tightness or chronic cough that is not associated with wheezing
- Vary in duration, severity, and frequency
Self Treatment with OTC
- Symptoms are mild, intermittent (<2/week), and of short duration (<24 hours)
- A prior diagnosis of intermittent asthma has been made by a PCP
- Pt knows the warning symptoms indicating the need for urgent medical care
- Pt does not have any other serious concurrent diseases that might impair oxygenation or breathing (COPD, CAD)
- The individual is >/= 4 yrs for nebulize treatment or >12 years old for oral, and not pregnant
- The current asthma symptoms are consistent with previous symptoms
- The nonprescription medications are for short-term (<24 hours) treatment of mild symptoms (until seen by PCP)
Exclusions for Self Treatment
- No previous diagnosis of asthma
- Concurrent condition (sx similar to asthma)
- Hx of asthma episodes severe enough to require systemic corticosteroids or urgent medical care
- Use of (or non-adherence to) other Rx long-term control medications for asthma
- No asthma care provider (not seen in >1yr)
- Pregnancy or <4 years of age or <12 years of age for oral
- Rx medications are ineffective
- Sx moderate/severe or more frequent than 2/week
- Sx have lasted more than 24 hr
- Sx unresponsive OTC asthma meds within 24 hr
- Sx of different quality/severity than previous episodes
- Signs and sx of respiratory/sinus infection
Non-pharmacologic Therapy
- Identify triggers
- Reduce exposure/eliminate triggers
- Reduce/eliminate tobacco smoke
- Ensure vaccinations are up to date (influenza, pneumococcal)
- Trigger screening tool
Asthma Medications: 2 groups
Quick-relief medications (rescue/reliever inhaler)
• Short-acting Beta2-agonist (SABA), ex: albuterol
• Epinephrine inhaler (OTC)
Long-term control medications (controller)
• Inhaled Corticosteroids (ICS)
• Combination ICS + Long-acting Beta2-agonist (LABA)
Non-prescription Products
- Racepinephrine nebulizer solution
- Ephedrine/guaifenesin
- Epinephrine metered-dose inhaler
Epinephrine
- Epinephrine (AKA adrenaline) is one of a group of monoamines called the catecholamines
- Epinephrine can bind to β2 adrenergic receptors and stimulate bronchodilation
Racepinephrine
- Adults / children 4years and older
- Pour 0.5mL (1 vial) into nebulizer reservoir
- Give 1 to 3 inhalations from nebulizer
- Not more than every 3 hours
- Do not exceed 12 inhalations per 24hr
Racepinephrine: Seek Medical Advice
- Breathing does not improve within 20 minutes - Breathing worsens - Patient uses >9 inhalations in 24 hr - Patient uses > 3 days/week - Patient has >2 asthma attacks within 1 week
Racepinephrine: Safety Considerations (AE/C)
- Adverse drug reactions: tachycardia, arrhythmias, nervousness
- Do not use with concomitant monoamine oxidase inhibitor (MAOi) therapy or for 2 weeks after stopping MAOi drug
- Contraindications: pregnancy, cardiac arrhythmias, coronary insufficiency, poorly controlled hypertension, seizures, hypokalemia, angina, hyperglycemia, and uncontrolled hyperthyroidism
- Do not use if brown in color or cloudy
Safety Considerations: Ephedrine and Guaifenesin
Ephedrine side effects:
- Palpitations, tachycardia, arrhythmias, seizures, hypokalemia, angina, hyperglycemia, hypotension, and hypertension
Guaifenesin side effects:
- Nephrolithiasis (kidney stones) – case reports have linked to guaifenesin alone and in combination with ephedrine
Epinephrine Inhaler
Brand name: Primatene Mist
- Dosage form: Metered-dose inhaler
- Only approved for mild, intermittent asthma
- Do not use if < 12 years old
- Not a replacement for Rx meds
- Inhale 1 puff by mouth, may repeat x1 after 1 minute
- Subsequent doses not given for 3 to 4hr
Epinephrine Inhaler: PCP, AE
See a physician if:
- Have never been diagnosed with asthma
- Not better in 20 minutes
- Symptoms get worse
- Need > 8 inhalations in 24 hours
- Have > 2 asthma attacks in a week
Adverse Reactions:
- Hyperactivity, restlessness, excitability, palpitations, headache, upper respiratory irritation, pharyngeal dryness
