asthma

Question 1

risk factors

Answer 1

Atopy (allergies, atopic dermatitis, family Hx)
-obesity
-GERD
-pregnancy
-smoking
-Allergens

Question 2

asthma diagnosis

Answer 2

Children
-FEV1/FVC 80-90% with 12% increase
Adult
-FEV1/FVC 75-80% with 12% or 200ml increase

Question 3

GINA questions

Answer 3

-Daytime Sx more than twice a week?
-Night waking from asthma?
-SABA use >2 times a week
-Activity limitation

Question 4

CTS questions

Answer 4

Any hospitalizations?
PEF diurnal variation (if day vs night differs by 10-15%

Question 5

SABA A/E

Answer 5

tachycardia
nervousness
tremor
insomnia (LABAs)

Question 6

SAMA A/E

Answer 6

dry mouth
metallic taste

Question 7

ICS A/E

Answer 7

-sore throat
-adrenal crisis

Question 8

LTRA A/E

Answer 8

headache, abdominal pain, depression, nightmares, increased suicide

Question 9

Prednisone A/E

Answer 9

Short term: fluid retention, glucose intolerance (hyperglycemia), increased BP
Long term: adrenal suppression, dermal thinning, diabetes, glaucoma, myopathy

Question 10

Treatment progress (CTS)

Answer 10

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

Question 11

12+ preferred treatment path (GINA)

Answer 11

1. PRN Symbicort 200/6
2. PRN Symbicort 200/6
3. Symbicort low dose 1 puff BID
4. Symbicort med dose 2 puff BID + Symbicort as receiver max 12/d
5. Add LAMA and refer

Question 12

12+ alternative path (GINA)

Answer 12

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

Question 13

6-11 preferred treatment (GINA)

Answer 13

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

Question 14

mild asthma

Answer 14

PRN symbicort
low dose daily ICS and SABA

Question 15

Moderate asthma

Answer 15

Step 3 or 4 (low dose QD or med dose)

Question 16

severe asthma

Answer 16

uncontrolled on high dose ICS+ LABA or triple therapy

Question 17

Green zone

Answer 17

controlled level
PEF >80% of personal best

Question 18

Yellow zone

Answer 18

PEF >60-80% of best, night time waking, >3 episodes in a week

Question 19

Yellow zone action for SABA PRN

Answer 19

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

Question 20

Yellow zone action for symbicort reliever

Answer 20

Continue maintenance and use PRN up to max 12 doses

Question 21

Yellow zone action for daily ICS + SABA

Answer 21

quadruple ICS if possible for 7-14d

Question 22

Yellow zone action for symbicort controller + SABA Or MART

Answer 22

if >16yo then Symbi 4 puffs BID F7-14D + symbi PRN max 12
if >12yo then symbi max 8 per day

Question 23

Yellow zone action for everything

Answer 23

prednisone for 5days is always an effective option

Question 24

Red zone

Answer 24

PEF 60% of personal best
-sudden severe SOB, cough, wheezing
-reliever only lasts 2-3 hours
GO TO THE HOSPITAL

Question 25

exercise induced asthma diagnosis

Answer 25

-Sx only after exertion
-FEV1/FVC test done after exertion or a positive bronchial challenge test

Question 26

exercise induced asthma diagnosis

Answer 26

Daily ICS to ensure SABA effectiveness
take SABA or MART before exercise
warm up and cool down

Question 27

work related asthma

Answer 27

Usually a trigger in the work place or area (sensitizer, irritant), do a strong social history

Question 28

Perimenstrual asthma

Answer 28

cyclical asthma with sex hormone trigger (tested by PEF during menstruation)
-normal GINA treatment but can increase ICS while approaching period

Question 29

Pregnancy

Answer 29

Limit oral steroids during first trimester
-use Budesonide as first line
-LTRA is safe
-LABAs are safe

Question 30

Breastfeeding

Answer 30

everything is safe except montelukast as it can enter milk (only a concern till 6 months)

Question 31

Yellow zone <12

Answer 31

Can not increase other medications, if SABA not working consider prednisone (1mg/kg F3-5D)