Asthma Flashcards
General Information
Inflammation & bronchoconstriction → airway obstruction & expiratory airflow limitation
Classic Symptoms: Recurrent wheezing, breathlessness, chest tightness & cough
Reversible: If FEV ↑12% with medication |
Exacerbations: Can be mild, severe or fatal
Triggers: Allergens, dust |
Smoke, chemicals, weather |
Lifestyle: Stress/exercise |
Med: ASA, NSAID, BB | Respiratory infections |
Comorbidity: Allergy, GERD, Obesity, Sleep apnea, Anxiety, Depression
Diagnosis: Spirometry; tests forced vital capacity in 1 second to assess expiratory volume: FEV1/FVC
Asthma Tx Algorithm
- Classify asthma severity → 2. Initiate treatment
- F/U 2-6 wks: Review and determine if asthma is under control: step-up, maintain, down. Assess adherence, counsel, control risks, triggers, comorbids:
Avoid: Smoking, Triggers |
▪Exercise: Even if EIB | Vaccines: Flu, Pneumovax 23
- Follow up 1-6 months if controlled
Guide to Spacers & Nebulizers
Spacers: Open tubes btwn mouthpiece & MDI for kids, dexterity issue,↓thrush |
Clean: QW in warm water
Nebulizer: Liquid med → mist & inhaled thru face mask w/natural breathing.
Two types: Jet & ultrasound
General guidance of Inhaler use
> 1 Inhalation: Wait 60 sec between each inhalation > 1 Inhaler: Sequence = SABA → LABA/LAMA → ICS
Asthma in Pregnancy
SABA is a must; Preferred controllers: budesonide (ICS)
Peak Flow Meters
Monitor asthma control [Peak expiratory flow rate] QAM before meds|
Clean: QW
Essential: Technique & best effort
Blow HARD & FAST
Record highest of 3 attempts
Peak Flow Meter Color Guides
% of Personal best
Green > 80 - 100%
Yellow: 50-80% → Action Plan
Red: < 50% → ER
Exercise Induced Bronchospasm (EIB)
Preferred preventative: SABA 2 inh 5-15 mins before exercise lasts 2-3hrs
▪ Longer duration: salmeterol (LABA) 30mins before*
*Do not use if already using for asthma maintenance.
▪ Alternative: montelukast taken 2hr prior lasts >24hr
*EIB is often a marker for inadequate asthma control
Classifying Asthma Severity
- Initiate Tx
- Asthma Control
Dry Powder Inhalers (DPI)
Diskus, Ellipta, Pressair, Handihaler, Neohaler, RespiClick, Flexhaler
Delivery: Fine powdered medication NO propellant |
Admin: QUICK & FORCEFUL (no buttons)
Do NOT shake | No priming (Except Flexhaler)
Advair Diskus Instructions
Pulmicort Flexhaler Instructions
ProAir and Airduo RespiClick
Metered Dose Inhalers - Key Features
HFA, Respimat or no suffix
Aerosolized liquid med w/propellant: HFA, CFC
Admin: SLOW & DEEP while pressing canister ▪
Spacer: PTs unable to coordinate breathing & pressing
Shake well: except QVAR RediHaler, Alvesco & Respimats
Metered Dose Inhalers - Counseling
- Shake inhaler for 5 seconds before use ▪except QVAR RediHaler/Alvesco
- Breathe out fully
- Inhale SLOW & DEEP while pressing top of canister with index finger
- Hold breath 10s or as long as possible
Ventolin HFA & ProAir HFA Priming Instructions
Spray 4x (3 for Proair) away from face while shaking
▪Prime if > 14 days since last use or drop
Flovent HFA & Dulera Priming Instructions
Spray 4x away while shaking.
▪ Prime: 1 spray if > 7 days last use | > 5 for Dulera
Symbicort Priming Instructions
Spray 2x while shaking.
▪ Prime if > 7 days last use
Ventolin HFA & ProAir HFA Cleaning Instructions
Remove metal canister & rinse mouthpiece with warm H2O, then air dry. (1x/wk)
Flovent HFA Cleaning Instructions
Clean cotton swab w/H2O to clean where med sprays. Air dry.
Dulera & Symbicort Cleaning Instructions
Do NOT put in water. Use clean, dry cloth to wipe inside and outside of mouthpiece.
SAMA - Description
Inhibits cholinergic: Bronchodilation | acute exacerbation
