asthma and how it relates to in office tx

Question 1

7 components of severity we look at to classify asthmatic as intermittent, mild, moderate and severe

Answer 1

1. symptoms
2. nocturnal awakenings
3. SABA use for symptom control (not for prevention of exercise induced bronchospasm)
4. interference with normal activity
5. lung function measured by FEV1 (%predicted)
6. exacerbations requiring the use of oral steroids
7. likely medications used in management for the subject

Question 2

SABA stands for?
LABA?
LAMA?
LTRA?
ICS?

Answer 2

short acting beta agonists –
long actin beta agnoists
long acting muscarinic agonsist
leukotriene receptor antagonist
inhaled corticosteroids

Question 3

FEV1

Answer 3

forced expiratory volume in 1 second
maximum amount of air that a subject can forcibly expel during the first second following maximal inhalation

Question 4

asthma is ___ type of disease

Answer 4

obstructive (vs being restrictive)
chronic inflammatory disorder - in part by CD4 T-lympocytes and eosinophils

Question 5

asthma classification

Answer 5

1. intermittent
2. persistent
   - mild
   -moderate
   -severe

Question 6

4 questions to ask as screening tool?
no to all?
yes to 1-2?
yes to 3-4?

Answer 6

in past FOUR week have you had…
1. daytime symptoms more than 2x per week?
2. any night waking due to asthma?
3. SABA reliever use for symptoms more than 2x per week?
4. any limitation of activity due to asthma?

Well-controlled Asthma: Report “no” to all of above questions.

Partly Controlled Asthma: Report “yes” to 1-2 of these questions.

Uncontrolled Asthma: Report “yes” to 3-4 of these questions

Question 7

avoid use of what in asthmatics?

Answer 7

any known triggers of histamine release such as
- NSAIDS and morphine

patients with recent URI are not candidates for deep sedation because increased risk of bronchospasm

Question 8

classification of intermittent asthmatic in relation to the 7 components of severity
1. symptoms
2. nocturnal awakenings
3. SABA use for symptom control (not for prevention of exercise induced bronchospasm)
4. interference with normal activity
5. lung function measured by FEV1 (%predicted)
6. exacerbations requiring the use of oral steroids
7. likely medications used in management for the subject

Answer 8

1. symptoms
   <2 days per week
2. nocturnal awakenings
   <2x per month
3. SABA use for symptom control (not for prevention of exercise induced bronchospasm)
   < days / week
4. interference with normal activity
   none
5. lung function measured by FEV1 (%predicted)
   >80 %
6. exacerbations requiring the use of oral steroids
   0-1/ year
7. likely medications used in management for the subject
   SABA as needed

Question 9

classification of mild / persistent asthmatic in relation to the 7 components of severity
1. symptoms
2. nocturnal awakenings
3. SABA use for symptom control (not for prevention of exercise induced bronchospasm)
4. interference with normal activity
5. lung function measured by FEV1 (%predicted)
6. exacerbations requiring the use of oral steroids
7. likely medications used in management for the subject

Answer 9

1. symptoms
   > 2 days per week but not daily
2. nocturnal awakenings
   3-4 x per month
3. SABA use for symptom control (not for prevention of exercise induced bronchospasm)
   > 2 days / week but NOT daily
4. interference with normal activity
   minor limitation
5. lung function measured by FEV1 (%predicted)
   >80%
6. exacerbations requiring the use of oral steroids
   >2x per year
7. likely medications used in management for the subject
   - low dose (ICS - inhaled corticosteroids), LTRA - leukotriene receptor antagonists

Question 10

classification of moderate/ persistent asthmatic in relation to the 7 components of severity
1. symptoms
2. nocturnal awakenings
3. SABA use for symptom control (not for prevention of exercise induced bronchospasm)
4. interference with normal activity
5. lung function measured by FEV1 (%predicted)
6. exacerbations requiring the use of oral steroids
7. likely medications used in management for the subject

Answer 10

1. symptoms
   daily
2. nocturnal awakenings
   >1x per week but NOT nightly
3. SABA use for symptom control (not for prevention of exercise induced bronchospasm)
   - daily
4. interference with normal activity
   some limitations
5. lung function measured by FEV1 (%predicted)
   60-80%
6. exacerbations requiring the use of oral steroids
   >2 / year
7. likely medications used in management for the subject
   -medium dose ICS, +/- LABA, LTRA

Question 11

classification of severe / persistent asthmatic in relation to the 7 components of severity
1. symptoms
2. nocturnal awakenings
3. SABA use for symptom control (not for prevention of exercise induced bronchospasm)
4. interference with normal activity
5. lung function measured by FEV1 (%predicted)
6. exacerbations requiring the use of oral steroids
7. likely medications used in management for the subject

Answer 11

1. symptoms
   several times per day
2. nocturnal awakenings
   often 7 nights per week
3. SABA use for symptom control (not for prevention of exercise induced bronchospasm)
   several times per day
4. interference with normal activity
   extremely limited
5. lung function measured by FEV1 (%predicted)
   <60%
6. exacerbations requiring the use of oral steroids
   >2x per year
7. likely medications used in management for the subject
   High dose ICS +LABA or LAMA, LTRA, daily oral corticosteroids* Biologic agents*