Asthma Flashcards
Asthma
a chronic disease of the airways that causes recurrent and distressing episodes
Symptoms of asthma
wheezing, breathlessness, chest tightness, nighttime or early am coughing
Asthma is triggered by
allergies, exercise, weather, certain foods, emotional states, outdoor pollution, smoke
Difference between asthma and COPD
onset in mid-life, symptoms progress slowly, long smoking history, dyspnea during exercise, irreversible airflow in COPD, opposite in asthma+ allergy, rhinitis, family history
Intermittent asthma
2x or less per week daytime symptoms, 2x or less per mo at noc
Mild persistent
> 2x/week daytime, 2x or less per mo at noc
Moderate persisstent
daily during day, 1x per week at noc
severe persistent
continual during day, frequent at noc
All pts classified in persistent asthma category will require what
controller medication
intermittent asthma treatment
short acting B2 agonist
persistent mild asthma treatment
low dose corticosteroids, short acting B2 agonist
persistent moderate asthma treatment
corticosteroids, LABA, SABA, alternatives or leukotriene modifiers, mast cell stabilizers
persistent severe asthma treatment
coricosteroids, LABA, SABA, alternatives leukotriene modifiers, mast cell stabilizers, oral corticosteroids, theophylline; poorly controlled regardless of age
Severity vs control
severity- the intrinsic intensity of the disease process, control- the degree to which the goals of therapy are met; severity is generally not discussed after diagnosis
persistent asthma step 6
high dose ICS+LABA and oral corticosteroid
Persistent asthma step 5
high dose ICS+LABA
Persistent asthma step 4
medium dose ICS+LABA
Persistent asthma step 3
low dose ICS+LABA or medium dose ICS
Persistent asthma Step 2
low dose ICS
Intermittent asthma step 1
SABA as needed
The basic approach
for persistent asthma start with a low dose ICS. Add LABA if not well controlled. Once a LABA is added titrate up ICS to maximal dose if still not controlled
if well controlled what do you do
after 3 months consider down stepping
Alternative agents
Monteludast (Singulair), Zafirlukast ( Accolate), Zileuton (Zyflo); for persistent, moderate asthma
Alternative agents MOA
leukotriene inhibitors, only available PO
Alternative agents ADRs
well tolerated, agitation (anxiety, hallucinations, unusual dreams)
Cromolyn (Intal)
alternative agents, mast cell stabilizer, only inhaler only, for persistent moderate asthma, very limited
Omalizumab (Xolair)
anti-IgE therapy, if failed everything else do this, moderate to severe asthma; ADRs anaphylaxis, HA, thrombocytopenia
Severe asthma, why do pts get hospitalized
non-adherence, continue exposure to triggers, incomplete assessment of co-morbidities, inadequate follow-up, pt response to meds
Risk factors of mortality
severe exacerbation, 2+ hospitalizations, 3+ ED visists in last year, >2 canisters/mon, diff perceiving symptoms, low socioeconomic, psych probs, comobidities
