Asthma Flashcards
What happens to the airways during an asthma exacerbation?
Experience smooth muscle tightening
Become inflamed
Fill with mucous
How do we reduce impairment for asthma?
Prevent sx Reduce SABA use Maintain pulmonary function Maintain normal activities Meet patient's satisfaction Meet family/caregiver satisfaction
How do we reduce risk for patients with asthma?
Prevent exacerbations Minimize emergency department visits Minimize hospitalizations Prevent lung loss Maintain lung growth Optimize therapy Prevent medication ADR
What are the components of asthma impairment?
Sx occurrences Nighttime awakenings Rescue medication use Interference with daily activity Lung function (FEV1, FEV1/FVC)
What are the types of medications for asthma use?
SABA Low dose ICS HD ICS Combination products Monoclonal antibodies Interleukin-5 receptor antagonist
What are parts of an environmental assessment?
Exposure to allergens and irritants
Co-morbid conditions
Gastrointestinal disease
What are co-morbid conditions that can affect asthma?
Pulmonary dz (pneumonia, flu) ENT dz Obstructive sleep apnea Rhinitis Sinusitis
What level of impairment has sx for = 2 days/week?
Intermittent
What level of impairment has sx for > 2 days per week?
Mild
What level of impairment has sx daily?
Moderate
What level of impairment has sx throughout the day?
Severe
What level of impairment has nighttime awakenings at >/= 5 years for = 2x/month?
Intermittent
What level of impairment has nighttime awakenings at >/= 5 years for 3-4x/month?
Mild
What level of impairment has nighttime awakenings at >/= 5 years for >1x/week?
Moderate
What level of impairment has nighttime awakenings at >/= 5 years for more often than 7x/week?
Severe
What level of impairment has nighttime awakenings at < 5 years for 1-2x/month?
Mild
What level of impairment has nighttime awakenings at < 5 years for 3-4x/month?
Moderate
What level of impairment has nighttime awakenings at < 5 years for >1x/wk?
Severe
What level of impairment is a patient that uses their SABA = 2 days/week
Intermittent
What level of impairment is a patient that uses their SABA > 2 days/weeks?
Mild
What level of impairment is a patient that uses their SABA daily?
Moderate
What level of impairment is a patient that uses their SABA several times per day?
Severe
What level of impairment is a patient that has a lung function of: 5-11 years
FEV > 80%
FEV/FVC > 85%
Intermittent
What level of impairment is a patient that has a lung function of: 5-11 years
FEV >/= 80%
FEV/FVC >/= 80%
Mild
What level of impairment is a patient that has a lung function of: 5-11 years
FEV 60-80%
FEV/FVC > 75-80%
Moderate
What level of impairment is a patient that has a lung function of: 5-11 years
FEV < 60%
FEV/FVC < 75%
Severe
What level of impairment is a patient that has a lung function of: >/=12 years
FEV > 80%
FEV/FVC normal
Intermittent
What level of impairment is a patient that has a lung function of: >/=12 years
FEV >/= 80%
FEV/FVC normal
Mild
What level of impairment is a patient that has a lung function of: >/=12 years
FEV > 60-80%
FEV/FVC reduced by 5%
Moderate
What level of impairment is a patient that has a lung function of: >/=12 years
FEV < 60%
FEV/FVC reduced by > 5%
Severe
What level of impairment is a patient if they have exacerbations requiring oral corticosteroids 0-1x/year?
Intermittent
How do you classify mild/moderate/severe impairment in patients the require oral corticosteroids for exacerbations?
< 5 years:
>/= 2x in 6 months requiring steroids OR >/= 4 wheezing episodes a year lasting > 1 day AND RF for persistent asthma
> /= 5 years: >/= 2x/year
What are Step 1 preferred treatments?
SABA PRN
What are Step 2 preferred treatments?
Low dose ICS
What are step 2 alternative treatments for patients < 5 yo?
Cromolyn/singulair
What are step 2 alternative treatments for patients >/= 5 yo?
Cromolyn
Nedocromil
LRTA
Theophylline
What are step 3 preferred treatments for patients < 5 years old
Medium dose ICS
What are step 3 preferred treatments for patients 5-11 years old?
Low dose ICS + LABA/LRTA/Theophylline
OR
Medium dose ICS
What are step 3 preferred treatments for patients >/= 12 years old?
Low dose ICS + LABA
OR
Medium dose ICS
What are step 3 alternative treatment options for >/= 12 years old?
Low dose ICS + LRTA/theophylline/zileuton
What are step 4 preferred treatments for patients < 5 years old?
Medium dose ICS + LABA/Singulair
What are step 4 preferred treatments for patients >/= 5 years old?
Medium dose ICS + LABA
What are step 4 alternative treatments for 5-11 year olds?
Medium dose ICS + LABA/theophylline
What are step 4 alternative treatments for >/= 12 year olds?
Medium dose ICS + LRTA/theophylline/zileuton
What are step 5 preferred treatments for < 5 years old?
High dose ICS + LABA/singulair
What are step 5 preferred treatments for 5-11 year olds?
High dose ICS + LABA
What are step 5 preferred treatments for >/= 12 year olds?
High dose ICS + LABA
AND
Consider omalizumab for patients who have allergies
What are step 5 alternative treatments for 5-11 year olds?
High dose ICS + LRTA/theophylline
What are step 6 preferred treatments for < 5 years old?
High dose ICS + oral corticosteroids + LABA/singulair
What are step 6 preferred treatments for 5-11 year olds?
High dose ICS + LABA + oral corticosteroids
What are step 6 preferred treatments for >/= 12 year olds?
High dose ICS + LABA + oral corticosteroids
AND
Consider omalizumab for patients who have allergies
What are step 6 alternative treatments for 5-11 year olds?
High dose ICS + LRTA/theophylline + oral corticosteroids
