asthma Flashcards
risk factors
Atopy (allergies, atopic dermatitis, family Hx)
-obesity
-GERD
-pregnancy
-smoking
-Allergens
asthma diagnosis
Children
-FEV1/FVC 80-90% with 12% increase
Adult
-FEV1/FVC 75-80% with 12% or 200ml increase
GINA questions
-Daytime Sx more than twice a week?
-Night waking from asthma?
-SABA use >2 times a week
-Activity limitation
CTS questions
Any hospitalizations?
PEF diurnal variation (if day vs night differs by 10-15%
SABA A/E
tachycardia
nervousness
tremor
insomnia (LABAs)
SAMA A/E
dry mouth
metallic taste
ICS A/E
-sore throat
-adrenal crisis
LTRA A/E
headache, abdominal pain, depression, nightmares, increased suicide
Prednisone A/E
Short term: fluid retention, glucose intolerance (hyperglycemia), increased BP
Long term: adrenal suppression, dermal thinning, diabetes, glaucoma, myopathy
Treatment progress (CTS)
1.Confirm diagnosis, educate, reliever
2. ICS daily (age dosing) LTRA 2nd line
3. >12 add LABA, <12 increase ICS
4. >12 Add LTRA or LAMA,<12 Add LABA or LTRA
5. Triple therapy and refer
12+ preferred treatment path (GINA)
- PRN Symbicort 200/6
- PRN Symbicort 200/6
- Symbicort low dose 1 puff BID
- Symbicort med dose 2 puff BID + Symbicort as receiver max 12/d
- Add LAMA and refer
12+ alternative path (GINA)
Reliever ICS/SABA or SABA
1.ICS when SABA is taken
2. Low dose QD ICS
3. Low dose QD ICS/LABA
4. Med to high dose ICS/LABA
5. Triple therapy
6-11 preferred treatment (GINA)
SABA reliever till step 3/4 then Symbi
1.low dose ICS with SABA
2.daily low dose ICS
3.low dose ICS+ LABA, Medium ICS, very low dose Symbicort
4.medium dose ICS + LABA, low dose Symbicort
5. High dose ICS + LABA and refer
mild asthma
PRN symbicort
low dose daily ICS and SABA
Moderate asthma
Step 3 or 4 (low dose QD or med dose)
severe asthma
uncontrolled on high dose ICS+ LABA or triple therapy
Green zone
controlled level
PEF >80% of personal best
Yellow zone
PEF >60-80% of best, night time waking, >3 episodes in a week
Yellow zone action for SABA PRN
Go to 2-4 puffs q20min for 3 doses
then if good response space to 3-4h PRN
but if no response Q1-3H PRN
Yellow zone action for symbicort reliever
Continue maintenance and use PRN up to max 12 doses
Yellow zone action for daily ICS + SABA
quadruple ICS if possible for 7-14d
Yellow zone action for symbicort controller + SABA Or MART
if >16yo then Symbi 4 puffs BID F7-14D + symbi PRN max 12
if >12yo then symbi max 8 per day
Yellow zone action for everything
prednisone for 5days is always an effective option
Red zone
PEF 60% of personal best
-sudden severe SOB, cough, wheezing
-reliever only lasts 2-3 hours
GO TO THE HOSPITAL
exercise induced asthma diagnosis
-Sx only after exertion
-FEV1/FVC test done after exertion or a positive bronchial challenge test
exercise induced asthma diagnosis
Daily ICS to ensure SABA effectiveness
take SABA or MART before exercise
warm up and cool down
work related asthma
Usually a trigger in the work place or area (sensitizer, irritant), do a strong social history
Perimenstrual asthma
cyclical asthma with sex hormone trigger (tested by PEF during menstruation)
-normal GINA treatment but can increase ICS while approaching period
Pregnancy
Limit oral steroids during first trimester
-use Budesonide as first line
-LTRA is safe
-LABAs are safe
Breastfeeding
everything is safe except montelukast as it can enter milk (only a concern till 6 months)
Yellow zone <12
Can not increase other medications, if SABA not working consider prednisone (1mg/kg F3-5D)
