Asthma Flashcards
What is the atopic triad?
infant atopic dermatitis
childhood allergic rhinitis
asthma
At what age should your diagnosis for asthma shift from therapeutic medicine trial to obtaining spirometry?
< 5 years old
On spirometry, what percentage of airway reversibility and change in FEV1 is consistent with asthma diagnosis?
12% and 200 mL
Diagnostic criteria for asthma on spirometry
FEV1 < 80% predicted
significant reversibility after inhaling SABA: 12% and FEV1 increase by 200 ml
What four historical points should you get from every asthmatic to help determine symptom burden?
- daytime symptoms
- nocturnal symptoms
- rescue SABA use
- activity limitations
Which asthma classification does this describe?
Symptoms < 2x/week
Nocturnal sx < 2x/month
Mild intermittent asthma
Which asthma classification does this describe?
Symptoms > 2x/week but not daily
Nocturnal sx > 2x/month
mild persistent
Which asthma classification does this describe?
Daily symptoms, daily SABA use, activities affected
Nocturnal sx > 2x/week
Moderate persistent asthma
Which asthma classification does this describe?
Continual symptoms
Frequent nocturnal symptoms
Severe persistent
What treatment is first line for mild to moderate allergic rhinitis?
Monotherapy with intranasal corticosteroids
second line: antihistamines, leukotriene modulators, immunotherapy
What is the most appropriate treatment for acute bronchospasm?
albuterol
inhaled SABA
Once a pt is diagnosed with mild or moderate persistent asthma, what must you include in their therapy
inhaled corticosteroids
What is the role of LABA therapy in asthma management?
Used in combination with low to medium dose Inhaled corticosteroids and are the preferred combo therapy for management of moderate and severe persistent asthma
How does outpatient asthma management change as a child ages?
Additional therapies are available, and inclusion of ICS + LABA is initiated earlier
When can you consider stepping down therapy in management of asthma?
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
what measurement should be obtained at each asthma visit, and used at home as pts evaluate the severity of symptoms
PEF = peak expiratory flow
- 80% or more of personal best = green
- 50-80% of personal best = yellow
- <50% of personal best = red zone
What is the definition of acute asthma exacerbation?
PEF decreased < 50% predicted personal best in conjunction with physical signs and symptoms
Management of acute asthma exacerbation
- Oxygen
- systemic corticosteroids
- inhaled nebs: ipratropium and SABA
How do you diagnose exercise-induced bronchoconstriction on spirometry?
10% decrease in FEV1 after exercise is diagnostic
Management of exercise induced bronchoconstriction
SABA pretreatment prior to exercise
low-dose ICS if not controlled
LABA not recommended
Management of asthma COPD Overlap syndrom
Treat toward predominant symtoms
Management of asthma during pregnancy:
- schedule of evals
- preferred SABA
- preferred controlled medication
- monthly eval
- albuterol is preferred SABA (cat C)
- Budesonide is preferred controller med
