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Guidelines (clinical) > Asthma > Flashcards

Asthma Flashcards

1
Q

When is an ER referral indicated in a pt with asthma?

A

Vitals: RR >30 rpm, Pulse >120 bpm
Pulse Ox: <91% or >91% with decrease below upon walking (Decompensation)
Peak flow: <50% of predicted

Any of the following symptoms:
Cyanosis, pulses paradoxus (pulse amplitude dec with inhalation), AMS, unable to speak d/t dyspnea (STRONG), use of accessory mm to breathe

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2
Q

What scenarios require referral to pulmonologist or allergist for asthma?

A
  1. After life-threatening asthma exacerbation
  2. After hospitalization for asthma
  3. 2+ oral corticosteroids needed in a yr
  4. Step 4+ in person >5 yo indicated
  5. Step 3+ in person <5 yo indicated
  6. Not controlled after 3-6 mo of active therapy and monitoring
  7. Unresponsive to Tx
  8. Asthma Dx uncertain
  9. Special testing needed: skin testing for allergies, bronchoscopy, complete PFTs
  10. Allergen immunotherapy candidate
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3
Q

What co-morbidities in a pt with asthma should lead to a referral to pulmonology or allergist?

A 
Nasal polyposis
Chronic sinusiitis
Severe rhinitis
Allergic bronchopulmonary aspergillosis
COPD
Vocal cord dysfunction
Etc.
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4
Q

What are 4 things that would warrant a consideration of a referral in a pt with asthma?

A

Step 3+ care in person >5 yo
Step 2+ care in person <5 yo
Psychosocial or psychiatric problem is interfering with asthma
Peak flow is 50-60% of predicted (STRONG)

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5
Q

What are 3 things that must be completed at EVERY visit for a pt with asthma?

A

Expiratory peak flow
Pulse ox (Resting, Ambulatory)
Asthma action plan (complete, review)

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6
Q

What are some things that should be asked at EVERY visit in a pt with asthma?

A

Freq. of Sx
How often Sx lead to inhaler use
ADLs
# of night time exacerbations

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7
Q

For the stepwise approach to asthma, what age should it be used in? Does it replace clinical decision making? How do you choose btwn different Tx options listed within a preferred or alternative therapy? What do you do before stepping up?

A

12 yo and up
No
Alphabetical order (weird)
Try the preferred Tx first after discontinuing the alternative (if an alternative was tried) then step up

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8
Q

What should happen at every step of asthma Tx?

A

Pt education
Environmental control
Management of co-morbidities

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9
Q

What Tx is preferred for Step 1?

A

Inhaled SABA PRN

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10
Q

What Tx is preferred for Step 2?

A

Low-dose inhaled corticosteroid with inhaled SABA PRN

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11
Q

What Tx alternatives are within step 2?

A

Cromolyn
Leukotriene receptor antagonist
Nedocromil
Theophylline

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12
Q

What must be monitored with Theophylline use?

A

Serum concentration levels

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13
Q

What should be considered for patients in levels 2-4 of stepwise Tx for asthma?

A

SubQ allergen immunotherapy for allergic asthma pts

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14
Q

For asthma exacerbations patients can use their SABA how many times and in what interval?

A

3 x with 20 minute intervals

may need short dose of oral steroids

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15
Q

What easy measure (relating to SABA use) can tell someone they are not managed at their current level and need to “step up”?

A

Using SABA 2+ days per week for Sx relief (not prevention of exercise induced bronchospasm)

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16
Q

What Tx is preferred for Step 3?

A

Low-dose inhaled corticosteroid
AND
Long-acting beta agonist or Medium-dose inhaled corticosteroid

with inhaled SABA PRN

17
Q

What Tx alternatives for Step 3?

A

Low-dose inhaled corticosteroid
AND
Leukotriene receptor antagonist or Theophylline or Zileuton

18
Q

Why is Zileuton a poor alternative to asthma therapy?

A

Lack of evidence

Need to monitor liver function

19
Q

What Tx is preferred for Step 4?

A

Medium-dose inhaled corticosteroid
AND
Long-acting inhaled beta agonist

with inhaled SABA PRN

20
Q

What Tx alternatives for Step 4?

A

Medium-dose inhaled corticosteroid
AND
Leukotriene receptor antagonist or Theophylline or Zileuton

21
Q

What Tx is preferred for Step 5?

A 
High-dose inhaled corticosteroid
AND
long-acting inhaled beta agonist
AND
Omalizumab (allergic pts)
22
Q

What Tx is preferred for Step 6?

A 
High-dose inhaled corticosteroid
AND
long-acting inhaled beta agonist
AND
Oral corticosteroid 
AND
Omalizumab (allergic pts)
23
Q

How long does a pt need to be controlled prior to them stepping down?

A

3 months

24
Q

The role of allergy in asthma is greater in (children or adults)

A

Children

25
Q

Immunotherapy has evidence behind multiple allergens or single?

A

Single

26
Q

What 3 allergens have the most evidence for immunotherapy?

A

House-dust mites, animal dander, pollen

Guidelines (clinical) (7 decks)

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