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
SAMA agents
Ipratropium
SABA - Description
Rescue therapy for ALL patients
ProAir HFA
Albuterol
Respiclick
Albuterol
Proventil
Albuterol
Ventolin
Albuterol
Xopenex Concentrate
Xopenex HFA
Levalbuterol
Asthmanefrin Refill
Racepinephrine
Treatment Algorithm
Primatene Mist
Epinephrine
Albuterol Key features
90 mcg/inh | Most 200 inh; Ventolin (some): 60 inh MDI/DPI: 1 - 2 inh Q4-6H PRN
Levalbuterol Key features
R-isomer of albuterol
Racepinephrine key features
Non-selective - do not use
Epinephrine key features
FDA: Mild, intermittent
SABA - Safety
ADR: Nervousness, tremor, tachycardia, palpitations, cough, hyperglycemia, ↓K