Asthma management Flashcards
Main goals of asthma management are to : (3)
1) optimize control of asthma symptoms
2) reduce the risk of exacerbations
3) minimize medication AE
Proper management of asthma includes:
1) patient eduction
2) control of asthma triggers
3) monitoring for changes in lung function
4) pharmacologic treatment - mainstay of management in most patients
Goals of treatment for asthma (don’t memorize, just have a general idea)
1) freedom from frequent or troublesome symptoms
2) few night-time awakenings (less than 3 / month)
3) minimal use of short acting rescue agents (less than 2 days per week)
4) optimized lung function
5) maintain normal ADL
6) satisfaction with baseline and care
How to reduce future risk in asthma patients?
1) prevention of recurrent exacerbation and need for higher levels of care
2) prevention of reduced lung growth in children and loss of lung function in adults
3) optimization of pharmacotherapy with minimal or no AE
Assessing asthma severity
Meant to give guidance as to the intensity of therapy likely needed to bring asthma under good control
- best used to help categorize patients who are NOT YET taking medications for control or only take a short acting bronchodilator
Asthma control assessment
Assessment is applicable to all patients regardless of treatment status
- well controlled, partly controlled, controlled
Initiating therapy for asthma exacerbation
1) PROMPT administration of SABA and rx at home for use
2) consider brief course of systemic glucocorticoids)
3) consider starting long term controller medication
Initiating therapy for previously untreated patients
1) immediate access to a SABA
2) initiate controller medications based on severity/ control and place them in the appropriate “step”
F/u monitoring for Asthma drug therapy
1) routine f/u of these patients is recommended every 6 months- more often if needed initially
2) checking for asthma control, lung function, exacerbations, inhaler technique, adherence to chronic therapy
3) inquire about medication ADRs, patient satisfaction with care, and QOL
4) ensure to prod for emergency care visits and prescription of ORAL GLUCOCORTICOIDS
- could just mean increasing controller meds
5) in poorly controlled ashtma, it may be necessary to “jump a step” (2–>4)
6) montelukast are sometimes a cost effective method before adding another inhaler
Step 1 adults (intermittent asthma)
SABA prn
Milder persistent asthma/ step2 adults
1) low dose ICS daily with SABA prn
Moderate persisttent asthma/ step 3 adults
1) combo lose dose ICS -fometerol (LABA) daily and 1-2 inhalations prn up to 12 inhalations / day
severe persistent asthma steps 4-6
combo medium dose ICS formoterol daily and 1 to 2 inhalations prn to 12 inhalations /day
Step 5
Step 6
Step 1 for adults use
SABA (prn)
Step 2 asthma treatment
Low dose ICS + SABA
Step 3 asthma treatment
low dose ICS + LABA + SABA
Step 4 asthma
Medium ICS + LABA + SABA
Step 5 asthma treatment
medium- high ICS + LABA + LAMA + SABA
Step 6 asthma
High ICS + LABA + LAMA + SABA + oral glucocorticoids + biologics?
Initiating Therapy during asthma exacerbations
1) prompt administration of SABA and prescription home for use ( age and ability appropriate delivery device)
2) consider brief course of systemic glucocorticoids (predinsone, methylprednisolone, prednisolone, dexamethasone)
3) Consider starting long-term controller medications - gauge severity/ control and place them in the appropriate “step”- realizing therapy may need to be stepped up or down
Initiating therapy for previously untreated patients
1) immediate access to a SAB
2) initiate controller medication based on severity/ control and place them in the appropriate “Step”
F/u monitoring
1) routine f/u of these patients is recommended every 6 months - more often if indicated
2) checking for asthma control, lung function, exacerbations, inhaler technique, adherence to chronic therapy
3) inquire about medication ADRs, patient satisfaction with care and qol
4) ensure to prod for emergency care visits - could mean they need an increase in their controller meds or they just got sick
5) if poorly controlled asthma, it may be necessary to “jump a step”
6) montelukast (ltra) are sometimes a cost-effective method before adding another inhaler
Last line therapy
1) uncontrolled patients on medium to high dose (ics and labas), consideration of adding OMALIZUMAB if there is objective evidence (allergy test) of sensitivity to a perennial allergen
2) Il-4 and Il-5 therapies are available for severe eosinophilic asthma - likely a referral to an asthma / allergy specialist at this point
Stepping down therapy
1) consider stepping down therapy when the patient has been well controlled for at least 3-6 months on a stable regimen
2) follow the same stepwise approach you would when going up in therapy, checking for all the same sxs/control/severity
3) minimize expense, inconvenience and potential ADRs
4) careful monitoring with an asthma action plan and proper response is important when stepping down- could prompt an exacerbation
