Asthma

Question 1

What is the atopic triad?

Answer 1

infant atopic dermatitis
childhood allergic rhinitis
asthma

Question 2

At what age should your diagnosis for asthma shift from therapeutic medicine trial to obtaining spirometry?

Answer 2

< 5 years old

Question 3

On spirometry, what percentage of airway reversibility and change in FEV1 is consistent with asthma diagnosis?

Answer 3

12% and 200 mL

Question 4

Diagnostic criteria for asthma on spirometry

Answer 4

FEV1 < 80% predicted

significant reversibility after inhaling SABA: 12% and FEV1 increase by 200 ml

Question 5

What four historical points should you get from every asthmatic to help determine symptom burden?

Answer 5

• daytime symptoms
• nocturnal symptoms
• rescue SABA use
• activity limitations

Question 6

Which asthma classification does this describe?

Symptoms < 2x/week
Nocturnal sx < 2x/month

Answer 6

Mild intermittent asthma

Question 7

Which asthma classification does this describe?

Symptoms > 2x/week but not daily

Nocturnal sx > 2x/month

Answer 7

mild persistent

Question 8

Which asthma classification does this describe?

Daily symptoms, daily SABA use, activities affected

Nocturnal sx > 2x/week

Answer 8

Moderate persistent asthma

Question 9

Which asthma classification does this describe?

Continual symptoms
Frequent nocturnal symptoms

Answer 9

Severe persistent

Question 10

What treatment is first line for mild to moderate allergic rhinitis?

Answer 10

Monotherapy with intranasal corticosteroids

second line: antihistamines, leukotriene modulators, immunotherapy

Question 11

What is the most appropriate treatment for acute bronchospasm?

Answer 11

albuterol

inhaled SABA

Question 12

Once a pt is diagnosed with mild or moderate persistent asthma, what must you include in their therapy

Answer 12

inhaled corticosteroids

Question 13

What is the role of LABA therapy in asthma management?

Answer 13

Used in combination with low to medium dose Inhaled corticosteroids and are the preferred combo therapy for management of moderate and severe persistent asthma

Question 14

How does outpatient asthma management change as a child ages?

Answer 14

Additional therapies are available, and inclusion of ICS + LABA is initiated earlier

Question 15

When can you consider stepping down therapy in management of asthma?

Answer 15

Step down can be considered if asthma is well controlled for 3 months or more

• decrease dose of ICS gradually by 25-50% every 3-6 months

Question 16

what measurement should be obtained at each asthma visit, and used at home as pts evaluate the severity of symptoms

Answer 16

PEF = peak expiratory flow

• 80% or more of personal best = green
• 50-80% of personal best = yellow
• <50% of personal best = red zone

Question 17

What is the definition of acute asthma exacerbation?

Answer 17

PEF decreased < 50% predicted personal best in conjunction with physical signs and symptoms

Question 18

Management of acute asthma exacerbation

Answer 18

• Oxygen
• systemic corticosteroids
• inhaled nebs: ipratropium and SABA

Question 19

How do you diagnose exercise-induced bronchoconstriction on spirometry?

Answer 19

10% decrease in FEV1 after exercise is diagnostic

Question 20

Management of exercise induced bronchoconstriction

Answer 20

SABA pretreatment prior to exercise

low-dose ICS if not controlled

LABA not recommended

Question 21

Management of asthma COPD Overlap syndrom

Answer 21

Treat toward predominant symtoms

Question 22

Management of asthma during pregnancy:

• schedule of evals
• preferred SABA
• preferred controlled medication

Answer 22

• monthly eval
• albuterol is preferred SABA (cat C)
• Budesonide is preferred controller med