Asthma Flashcards
1
Q
Diagnosis of asthma in preschoolers (age 1-5)
A
- 2 or more sx of asthma sx or exacerbations
- Documentation of airflow obstruction (preferred MD, alternative parent)
- Documentation of reversibility (preferred MD/HCP shows improvement of SABA +/- PO steroids, alternative parent reported improvement with 3 mth trial of medium dose ICS, alternative parent report of improvement w/ SABA)
- No other alternative diagnosis
2
Q
Management of those in yellow zone (acute loss of control)
A
- Ages 15 years and below, no increase in controller therapy; PO steroids PRN
- However if 12 and up, could use bud/form as reliever & controller
- Age 16+ depends on their current treatment
- If no maintenance, consider starting regular controller therapy or bud/form
- If on PRN bud/form, increase to max of 8 inh per day
- Daily ICS or LTRA, 4 fold increase in ICS x 7-14 d
- Daily bud/form, inc to max 4 inh BID x 7-14d
- Daily ICS/LABA, inc ICS 4 fold for 7-14 d
- 2nd choice is to start PO steroids
3
Q
State risk factors for severe asthma exacerbation
A
- Any hx of severe asthma exacerbation (ED visit, hospitalization, PO steroids)
- Poorly controlled asthma
- Overuse of SABA (defined as use of more than 2 inhalers of SABA in a year)
- Current smoker
4
Q
State risk factors for fatal or near-fatal asthma
A
- Any previous near-fatal asthma exac (e.g. prev ICU admission, ventilation, respiratory acidosis)
- Recurrent hospitalizations or ED visits in last year
- Severe asthma
- Overuse of SABA
- Poor adherence
- Failure to attend clinic appts
- Psychiatric illnesses (e.g. depression, anxiety)
- Alcohol or other substance use
- Obesity
- Severe domestic, marital, employment, local stress
- Denial of illness or severity of illness
5
Q
Name all inhaled steroids (ICS, ICS/LABA)
A
- Ciclesonide - Alvesco
- Fluticasone propionate - Flovent, Advair (+salmeterol)
- Fluticasone furoate - Arnuity, Breo (+vilanterol)
- Mometasone furoate - Asmanex, Zenhale (+formoterol)
- Budesonide - Pulmicort, Symbicort (+formoterol)
- Beclomethasone diproprionate - Qvar
Licensed for once daily dosing:
- Pulmicort (budesonide), Alvesco (ciclesnoide), Arnuity (fluticasone furoate), Asmanex (mometasone)
6
Q
Outline components of an asthma education program
A
- Asthma pathophysiology - chronic inflammatory condition with hyper-reactivity
- Identify triggers - and avoid
- Asthma control for all patients
- Minimal to no exacerbations for all patients - identify RF for asthma exac
- Reliever vs controller
- Written action plan
- Medication safety & side effects
- Inhaler teaching
7
Q
State the approval age for Zenhale and Symbicort
A
Zenhale --> age 5 and up Symbicort --> age 12 and up Flovent --> approved in those 1 yoa Qvar --> approved in those 5 yoa Alvesco --> approved in those 6 yoa
