Asthma

Question 1

What are treatment options for an asthma exacerbation?

Answer 1

Salbutamol (SABA - short acting beta agonist)
Ipratropium (SAMA - short acting muscarinic antagonist)
Steroids
Magnisum Sulfate
If severe or impending respiratory failure, then SC epinephrine
Bipap

Intubation as a LAST resort

Question 2

List 3 triggers of asthma

Answer 2

URTI
Allergen (pets)
Irritant (Smoking)
Exercise 
Occupational exposures

Question 3

List nonpharmacologic treatment options/plan for asthma

Answer 3

Smoking Cessation
Avoid triggers
Flu shot
Asthma action plan

Question 4

What is first line pharmacological treatment for chronic asthma?

Answer 4

SABA
ICS
Age appropriate spacer device (don’t forget this**)

Question 5

List treatment options for asthma maintenance medications (drug classes)

Answer 5

SABA (Ventolin)
ICS (e.g flovent)
LABA: Long acting beta 2 Agonist ( such as symbicort or Advair)
* No LABA monotherapy*
LTRA: Leukotriene receptor antagonist (Singulair)

Question 6

What are symptoms of adequate asthma control? List 4.

Answer 6

Daytime symptoms: less than 4 days per week
Night time symptoms: less than 1 night per week
Physical activity: normal
Exacerbation: mild, infrequent
Absence from work/school: none
FEV1 or PEF: >= 90% of personal best

Question 7

What are reasons for poor control despite ICS in asthma? List 3.

Answer 7

Wrong diagnosis 
Poor inhaler technique
Poor adherence to ICS
Ongoing trigger exposure 
Comorbidities

Question 8

What is the diagnostic criteria for asthma in children age 1-5?

Answer 8

Require all three of the following during >= 2 episodes:
1. Documentation of airflow obstruction (cough, dyspnea, wheeze)
2. Documentation of reversibility
Preferred: physician observed improvement in signs of airflow obstruction to SABA +/- oral corticosteroid
Alternative: parental report of improvement to 3 month trial of medium dose ICS
3. No clinical evidence of an alternative diagnosis

Question 9

What time of the day should montelukast (singulair) be taken?

Answer 9

At bedtime

Administration of montelukast at bedtime ensures that maximal plasma concentrations of the drug coincide with the early morning maximal airway narrowing.