Asthma

Question 1

Asthma Goals

Answer 1

Optimize control of asthma symptoms
Reduce risk of exacerbations
Minimize medication adverse effects
Patient education, control of triggers, monitoring for changes, pharmacologic treatment

Question 2

Steps

Answer 2

1: SABA PRN
2: Low dose ICS and SABA
3: Low dose ICS and LABA and SABA
4: Medium dose ICS and LABA and SABA
5: Medium-high dose ICS and LABA and LAMA and SABA
6: High ICS and LABA and LAMA and SABA and oral glucocorticoids and biologics

Question 3

Asthma Exacerbation

Answer 3

Prompt SABA and prescription for home use based on age and ability
Consider brief course of glucocorticoids and long-term meds

Question 4

Follow-up Monitoring

Answer 4

Routine follow-up every 6 months
Check for asthma control, lung function, exacerbations, inhaker technique, etc
Inquire about their life and med ADRs
Prod for ER visits
Move steps in poor control
Montelukast (LTRA) is a cost-effective method before adding an inhaler

Question 5

Last Line Therapy in Asthma

Answer 5

Uncontrolled pts on med-high dose ICS and LABAs, consider adding omalizumab
IL4 and IL5 therapies for severe eosinophilic asthma

Question 6

Step Down Therapy

Answer 6

If pt has been well controlled for 3-6 months on a stable regimen
Check for all the same S/s
Minimizes expense
Be careful, may prompt an exacerbation.