Asthma Deck 2 Flashcards
Step 3 and 4 – 4 year olds with persistent
asthma – follow
step 3 and 4 (5-11 y.o.)
– Daily and PRN combination low-dose ICSformoterol
or daily and PRN combination
medium-dose ICS-formoterol
Steps 2–4: for 5 to 11 note
Conditionally recommend the use of subcutaneous immunotherapy as an adjunct treatment to standard pharmacotherapy in individuals ≥ 5 years of age whose asthma is controlled at the initiation, build up, and maintenance phases of immunotherapy
SMART Therapy
ICS-formoterol – single maintenance and
reliever therapy used both daily and as
needed
12+ step two notes
mild persistent asthma, either of the following two treatments are recommended as part of Step 2 therapy: 1) a daily low-dose ICS and as-needed SABA for quick-relief therapy,
12+ step 2 - 4 notes
SCIT – evidence of worsening
allergies after exposure
12+ step 3 and 4 notes
moderate to severe
persistent asthma taking low or medium dose
ICS, preferred treatment – SMART therapy
Asthma Control
Well-controlled, not-well controlled and very
poorly controlled.
• In patients already taking controller asthma
therapy
• Medication is adjusted according to asthma
control
• Therapy should be reassessed at each visit
• Asthma is a variable condition
• The management of asthma changes with the
patient’s needs over time.
• Stepwise approach to management
Important to reduce exposure
to allergens
and triggers
sources of allergens
house dust mites, pets, cockroaches, mold
factors that can exaerbate asthma
tobacco smoke, wood smoke, household sprays
goals of acute exacerbation
Relieve airway obstruction and hypoxemia, and
normalize lung function as quickly as possible
initial therapy for acute asthma exacerbation
– Oxygen—To relieve hypoxemia
– A systemic glucocorticoid—To reduce airway inflammation
– A nebulized, high-dose SABA—To relieve airflow obstruction
– Nebulized ipratropium—To further reduce airflow obstruction
Excercise induced cause
bronchospasm secondary to loss of heat and/or
water from the lung
exercise induced startes
either during or immediately after exercise, peaks
in 5 to 10 minutes, and resolves 20 to 30 minutes later
exercise induced treatment
SABA or cromolyn administered prophylactically
– Inhaled SABAs generally preferred over cromolyn
• Beta2 agonists should be inhaled immediately before
exercise
• Cromolyn should be inhaled 15 minutes before exercise
All people with asthma should have
a written asthma action plan to guide their self-managment eforts
Follow up, how often and what do you do
- Follow-up in 1 to 2 weeks
- Monthly
- Asthma Control Test
- Consider step-down, when possible
GINA no longer
recommends treatemnt with a SABA alone
GINA recomeneds
ICS to reduce risk of sercious excerbations
GINA recomends what for mild asthma
For mild asthma, as-needed low-dose ICS
and low-dose formoterol are recommended
(USA black box warning).
If formoterol is not available, the patient should
take l
low-dose ICS whenever SABA is taken
GINA mild asthma/well controlled recomendations
Well-controlled with as-needed
reliever medication alone or with low-intensity
controller treatment such as low-dose inhaled
corticosteroids (ICSs), leukotriene receptor
antagonists, or chromones
GINA moderate asthama recomendations
Well-controlled with lowdose
ICS/long-acting beta2-agonists (LABA)
GINAL severe asthma recomendations
Requires high-dose
ICS/LABA to prevent it from becoming
uncontrolled, or asthma that remains
uncontrolled despite this treatment
