Asthma

Question 1

What is the pathophysiology of Asthma?

Answer 1

Inflammation
and
Bronchoconstriction

Question 2

How is Asthma diagnosed?

Answer 2

With the use of Spirometry (used in PCP only) and Pulmonary Function Test

Peak flow meter can be used in diagnosis but is mostly used to monitor asthma control

Question 3

How is Spirometry used?

Answer 3

Check at FEV1 baseline
then
use a short acting bronchodilator (albuterol)
then 
Check FEV1 again 

If the FEV1 increases by more than 12% then = Asthma

Question 4

What are some rescue drug for the treatment of Asthma?

Answer 4

***Inhaled low dose ICS + Formoterol (Dulera & Symbicort)

***Inhaled short-acting beta 2 agonist (SABA)

Systemic steroids- for exacerbation or sever asthma

Inhaled epinephrine - OTC

Question 5

What are some maintenance or controllers drug for the treatment of Asthma?

Answer 5

Inhaled corticosteroids (ICS)

Inhaled long acting beta 2 agonist (LABA)

Oral leukotriene receptor antagonists (LTRA)

Theophylline

Inhaled long acting muscarinic antagonists (LAMA)

Monoclonal antibodies

Question 6

What is the first line controller med for all patient with persistent asthma?

Answer 6

Inhaled corticosteroids (ICS)

Question 7

True or False: All patient regardless of severity of Asthma should have a rescue inhaler.

Answer 7

True

Question 8

What drugs are used in step 1 (intermittent asthma)?

Answer 8

SABA as needed

Question 9

What drugs are used in step 2 (mild persistent asthma)?

Answer 9

Low- dose ICS

Question 10

What drugs are used in step 3 (moderate persistent asthma)?

Answer 10

Low-dose ICS + LABA
or
Medium-dose ICS

Question 11

What drugs are used in step 4 (severe persistent asthma)?

Answer 11

Medium-dose ICS + LABA
or
Medium-dose ICS + either LTRA, Therophyllin, or Zileuton

Question 12

What drugs are used in step 5 (severe persistent asthma)?

Answer 12

High-dose ICS + LABA
and
Consider Omalizumab for patients who have allergies

Question 13

What is drugs are used in step 6 (severe persistent asthma)

Answer 13

High-dose ICS + LABA + oral Corticosteroid
and
Consider Omalizumab for patients who have allergies

Question 14

What are some Beta 2 Agonists used in the rescue treatment of Asthma? (2)

Answer 14

Albuterol

Levalbuterol (Xopenex)

Question 15

Beta 2 Agonists in Asthma ADE

Answer 15

Nervousness
Increased HR
Cough 
Hyperglycemia 
Decreased Potassium

Question 16

What are some Inhaled Corticosteroid used in the treatment of Asthma? (4)

Answer 16

Beclomethasone (QVAR)
Budesonide (Pulmicort)
Fluticasone (Flovent)
Mometasone (Asmanex)

Question 17

What are some Inhaled Corticosteroid + LABA combinations products used in the treatment of Asthma? (4)

Answer 17

Fluticasone + Salmeterol (Advair)
Fluticasone + Vilanterol (Breo Ellipta)
Budensonide + Formoterol (Symbicort)
Mometasone + Formoterol (Dulera)

Question 18

Inhaled Corticosteroid ADE

Answer 18

Dysphonia (difficulty speaking)
Oral candidiasis (thrush)
Cough

Question 19

True or False: Inhaled Corticosteroid + Formoterol can be used as a rescue inhaler.

Answer 19

True

Question 20

Which LABA is used in the treatment of Asthma and comes as a single agent (i.e not in a combo formulation)?

Answer 20

Salmeterol (Serevent) only

no other LABA can be used in Asthma without it being in combination with another agent

Question 21

What are some LAMA used in the treatment of Asthma?

Answer 21

Tiotropium (Spiriva) only

no other LAMA can be used in Asthma

Question 22

What drug or drug combinations are FDA approved for use in COPD but not in Asthma treatment?

Answer 22

SAMA (all)
LAMA + LABA
LAMA + LABA + ICS

Question 23

What are the brand name identifiers for MDI (metered dose inhalers)?

Answer 23

HFA
Respimat
or if product doesn’t have a suffix assume its MDI

Question 24

What are the brand name identifiers for DPI (dry powder inhalers)?

Answer 24

Diskus 
Ellipta
Pressair
Handihaler
Neohaler
RespiClick
Flexhaler

Question 25

What is the method of inhalation patients should practice when using a DPI? In other words, how should patients inhale drug?

Answer 25

Requires a QUICK and FORCEFUL inhalation

Question 26

What is the method of inhalation patients should practice when using a MDI? In other words, how should patients inhale drug?

Answer 26

Requires a SLOW and DEEP inhalation

Question 27

Is shaken or priming needed for DPI?

Answer 27

No except for Flexhalers need priming and only prior to first use

Question 28

What are some Leukotriene modifying agents used in the treatment of Asthma?

Answer 28

Montelukast (Singulair)

Question 29

How can patients prevent exercise induced bronchospasm?

Answer 29

Take a SABA 5 to 15 minutes before exercise this should last 2 to 3 hours

Question 30

What is the preferred drugs in the treatment of Asthma in pregancy?

Answer 30

SABA + ICS: Budesonide (Pulmicort) is preferred

Question 31

What is the monoclonal antibody agent used in the treatment of Asthma?

Answer 31

Omalizumab (Xolair) SC

Question 32

Peak flow meter basics....

Answer 32

- Check every morning upon awakening and before the use of an asthma medications - Blow out as hard and as fast as possible. Write down the PEFR - Repeat step 2 more times with enough rest in b/w - Clean once a week

Question 33

Zone of asthma action per Peak flow meter....

Answer 33

Green zone: > 80 - 100% of personal best - Continue routine maintenance plan Yellow zone: 50 - 80% of personal best - Caution, worsening lung function - Increase in rescue inhaler use and the addition or increase of other medication Red zone: < 50% of personal best - Medication alert - Go to emergency department