Asthma Flashcards
FEV1 and FVC
FEV1: This is the amount of air that can be forcefully exhaled in one second.
FVC: The max volume of air that is exhaled after taking a deep breath
FEV1/FVC: This is the percentage of total air capacity (Vital capacity) that can be forcefully exhaled in 1 second
Asthma diagnostic criteria
1- Measure baseline FEV1 with spirometry
2- Give Albuterol
3- Measure post-bronchodilator FEV1
Asthma Diagnosis: An FEV1 increase > 12% means it is reversible and the patient is then diagnosed with Asthma
Asthma Severity
Asthma severity is classified based on several factors such as daytime symptoms, nighttime awakenings, rescue inhaler use, lung function.
Rescue Inhaler Use: (*Know this!)
Good indicator of severity:
1) Intermittent: <= 2 days/ week (STEP 1)
2) Persistent:
- Mild: > 2 days/week but not daily (STEP 2)
- Moderate: Daily (STEP 3)
- Severe: Several times per day (STEP 4 & 5)
Rescue Drugs
1) Low Dose ICS + Formoterol <——Preferred Reliever (Dulera, Symbicort)
2) SABA (Short Acting Beta-2 Agonists)
3) Systemic Steroids
4) SAMA (Short Acting Muscarinic Antagonists)
Maintenance Drugs (Daily Meds)
-Taken DAILY to reduce the risk of having an exacerbation
1) Inhaled Corticosteroids (ICS) <—-Preferred
2) LABA (Long-acting Beta-2 agonists)
-NEVER USED ALONE in Asthma
-Use in combination with another agent
3) LAMA (Long acting Muscarinic Antagonists) - Spiriva Respimat
4) LTRAs (Leukotriene Receptor Antagonists)
5) Theophylline
6) Monoclonal Antibodies
Step 1 (Intermittent Asthma)
Rescue Inhaler Use < 2days/week
1) PRN low-dose ICS+Formoterol
OR
2) PRN low-dose ICS+SABA
*If symptoms are worsening, we move to step 2 by adding a daily ICS
Step 2 (Mild Persistent Asthma)
1) Daily low-dose ICS
OR
2) PRN low-dose ICS+Formoterol
*If symptoms are worsening, we move to step 3 by adding a LABA
Step 3 (Moderate Persistent Asthma)
1) Daily low-dose ICS+LABA
*At this point, if symptoms are worsening, we move up a step by increasing ICS dose
Step 4 & 5 (Severe Persistent Asthma)
STEP 4
1) Medium-dose ICS+LABA
STEP 5
1) High-dose ICS+LABA
Beta-2 Agonists -SABA & LABA
SABA (Albuterol)
-PRN only
-200 inhalations/canister
-ProAir Respiclick (Dry Powder Formulation)
-Primatene (OTC Epinephrine)
LABA (Salmeterol, Formoterol)
-Boxed Warning: not for monotherapy in Asthma
Side Effects:
-Nervousness/tremor, tachy, palpitations, cough, Increase BG, Decrease K
-We sometimes use Albuterol in hyperkalemia, so when a patient is overusing their albuterol, we can see a decrease in potassium.
Exercise-Induced Bronchospasm: Rescue inhaler 5-15 minutes before exercise
Inhaled Corticosteroid
ICS:
1) Beclomethasone (QVAR)
2) Budesonide (Pulmicort)
3) Fluticasone (Flovent)
ICS+LABA:
1) Budesonide/Formoterol (Symbicort) <—Also used as rescue inhaler
2) Mometasone/Formoterol (Dulera) <—Also used as rescue inhaler
3) Fluticasone/Salmeterol (Advair, AirDuo) <—longer onset therefore not used as rescue
4) Fluticasone/Vilanterol (Breo Ellipta) <—longer onset therefore not used as rescue
MDI vs DPI
MDI - liquid medication
-HFA, Respimat, or no suffix
-Spacer can be used
-Admin: Slow, deep inhalation
DPI - dry powder
-Diskus, Ellipta, Pressair, Handihaler, Neohaler, Respiclick, Flexhaler
-Spacer cannot be used
-Admin: Quick, forceful inhalation (nothing to press)
Leukotriene Modifying Agents
*Add on therapy
1) Montelukast (Singulair)
-MOA: Blocks receptor
- >1 yo
-Daily dosing
-Take in evening due to Neuro-psych events that can occur
2) Zafirlukast (Accolate) BID
3) Zileuton (Zyflo) QID
Theophylline
*Add on therapy
-Dosed in IBW
-Broken down into caffeine..side effects similar to caffeine
-Conversion to aminophylline
-Therapeutic Range: 5-15 mcg/mL (Know this!)
Other Asthma Medications
LAMA:
1) Tiotropium (Spiriva Respimat) >6 y.o only
Monoclonal Antibodies: <—Indicated for moderate to severe allergic asthma
1) Omalizumab (Xolair)
IRA (Interleukin Receptor Antagonists): <—Indicated for severe asthma with Eosinophilic Phenotype
1) Mepolizumab (Nucala)
2) Reslizumab (Cinquair)
3) Benralizumab (Fasenra)
4) Dupilumab (Dupixent)
