Asthma Flashcards
What do levels of NO correlate with
Inflammation
When should you do objective tests on a child with suspected asthma?
When they reach age 5
What to do if suspect occupational asthma?
Refer to specialist
What diagnostic testing should patients over 17 have?
Spiro with bronchodilator reversibility testing
AND
FeNO
What diagnostic testing should children 5-16 have?
spirometry with a bronchodilator reversibility test
FeNO if there is normal spirometry or obstructive spirometry with a negative bronchodilator reversibility
What is positive FeNO value
adults = more than 40 parts per billion
children = more than 35
What is positive spiro and BDR
FEV1/FVC less than 0.7
Reversibility testing:
Adults: improvement in FEV1 of 12% or more AND increase in volume of 200 ml or more.
Children: Improvement in FEV1 of 12% or more
Step 1 asthma management
SABA
Step 2 asthma management and when would you move to this?
SABA & low dose ICS
Move to this if not controlled on SABA
OR
Newly-diagnosed asthma with symptoms >= 3 / week or night-time waking
Step 3 asthma management
SABA + low-dose ICS + leukotriene receptor antagonist
What is low/med/high dose ICS
<= 400 micrograms budesonide or equivalent = low dose
400 micrograms - 800 micrograms budesonide or equivalent = moderate dose
> 800 micrograms budesonide or equivalent= high dose.
Step 4 asthma management
SABA + low-dose ICS + long-acting beta agonist (LABA)
Continue LTRA depending on patient’s response to LTRA
Examples of LABA
Formoterol, salmeterol, indacaterol
Step 5 asthma management
SABA +/- LTRA
Switch ICS/LABA for a maintenance and reliever therapy (MART), that includes a low-dose ICS
MART has ICS and LABA
Step 6 asthma management
SABA +/- LTRA + medium-dose ICS MART
OR consider changing back to a fixed-dose of a moderate-dose ICS and a separate LABA
