Asthma management

Question 1

Main goals of asthma management are to : (3)

Answer 1

1) optimize control of asthma symptoms
2) reduce the risk of exacerbations
3) minimize medication AE

Question 2

Proper management of asthma includes:

Answer 2

1) patient eduction
2) control of asthma triggers
3) monitoring for changes in lung function
4) pharmacologic treatment - mainstay of management in most patients

Question 3

Goals of treatment for asthma (don’t memorize, just have a general idea)

Answer 3

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

Question 4

How to reduce future risk in asthma patients?

Answer 4

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

Question 5

Assessing asthma severity

Answer 5

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

Question 6

Asthma control assessment

Answer 6

Assessment is applicable to all patients regardless of treatment status
- well controlled, partly controlled, controlled

Question 7

Initiating therapy for asthma exacerbation

Answer 7

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

Question 8

Initiating therapy for previously untreated patients

Answer 8

1) immediate access to a SABA

2) initiate controller medications based on severity/ control and place them in the appropriate “step”

Question 9

F/u monitoring for Asthma drug therapy

Answer 9

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

Question 10

Step 1 adults (intermittent asthma)

Answer 10

SABA prn

Question 11

Milder persistent asthma/ step2 adults

Answer 11

1) low dose ICS daily with SABA prn

Question 12

Moderate persisttent asthma/ step 3 adults

Answer 12

1) combo lose dose ICS -fometerol (LABA) daily and 1-2 inhalations prn up to 12 inhalations / day

Question 13

severe persistent asthma steps 4-6

Answer 13

combo medium dose ICS formoterol daily and 1 to 2 inhalations prn to 12 inhalations /day

Question 14

Step 5

Question 15

Step 6

Question 16

Step 1 for adults use

Answer 16

SABA (prn)

Question 17

Step 2 asthma treatment

Answer 17

Low dose ICS + SABA

Question 18

Step 3 asthma treatment

Answer 18

low dose ICS + LABA + SABA

Question 19

Step 4 asthma

Answer 19

Medium ICS + LABA + SABA

Question 20

Step 5 asthma treatment

Answer 20

medium- high ICS + LABA + LAMA + SABA

Question 21

Step 6 asthma

Answer 21

High ICS + LABA + LAMA + SABA + oral glucocorticoids + biologics?

Question 22

Initiating Therapy during asthma exacerbations

Answer 22

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

Question 23

Initiating therapy for previously untreated patients

Answer 23

1) immediate access to a SAB

2) initiate controller medication based on severity/ control and place them in the appropriate “Step”

Question 24

F/u monitoring

Answer 24

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

Question 25

Last line therapy

Answer 25

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

Question 26

Stepping down therapy

Answer 26

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