Asthma Meds

Question 1

Budesonide

Answer 1

Inhaled corticosteroid nebulizer suspension approved for children age 1-8 (SABA)

Question 2

Fluticasone

Answer 2

Inhaled corticosteroid dry-powder inhalation approved for children age 4 and older

Question 3

Combined salmeterol/flucitasone

Answer 3

Dry powder inhalation or HFA MDI approved for children 4 and older

Question 4

Moteleukast (2)

Answer 4

CONTROL

1. LTRA 4mg chewable tablet for 2-6 years old
2. LTRA 4mg granules approved for 1 and older

Question 5

Cromolyn nebulizer

Answer 5

CONTROL; Approved for 2 and up

Question 6

Severity of asthma with stepwise approach (4)

Answer 6

Intermittent: Step 1

Mild persistent: Step 2

Moderate persistent: Step 3 or 4

Severe persistent: Step 5 or 6

Question 7

Stepwise approach for managing asthma in 0-4 years old (6 steps)

Answer 7

Step 1: SABA PRN

Step 2: Low dose ICS (alt: Cromolyn or Monteleukast)

Step 3: Medium dose ICS
*Consult with asthma specialist

Step 4: Medium dose ICS + either LABA or Monteleukast

Step 5: High dose ICS + either LABA or Monteleukast

Step 6: High dose ICS + either LABA or Monteleukast w/ oral systemic corticosteroids

Question 8

Stepwise approach for managing asthma in 5-11 years old (6 steps)

Answer 8

Step 1: SABA PRN

Step 2: Low dose ICS (alternative: LTRA, Cromolyn Nedocromil or Theophylline)

Step 3: Either low dose ICS + LABA, LTRA or Theophylline OR Medium dose ICS

Step 4: Medium Dose ICS + LABA (Alt: Medium Dose ICS + either LTRA or Theophylline)

Step 5: High Dose ICS + LABA (Alt: High dose ICS + either LTRA or Theophylline)

Step 6: High dose ICS + LABA + OCS (Alt: High dose ICS + either LTRA or Theophylline + OCS)

Question 9

Stepwise approach for managing asthma in 12 and older (6 steps)

Answer 9

Step 1: SABA PRN

Step 2: Low dose ICS (alternative: LTRA, Cromolyn Nedocromil or Theophylline)

Step 3: Low dose ICS + LABA -OR- Medium Dose ICS

Step 4: Medium Dose ICS + LABA (Alt: Medium Dose ICS + either LTRA or Theophylline or Zileuton)

Step 5: High Dose ICS + LABA -AND- Consider Omalizumab for patients with allergies

Step 6: High dose ICS + LABA + OCS -AND- Consider Omalizumab for patients with allergies

Question 10

Assessing Control in 0-4 years old (well, not well, very poorly controlled)

Answer 10

Well Controlled: symptoms = 2 days/week, nighttime awakenings only 1x/month, no interference with normal activity and SABA use only =2 days/week

Not Well Controlled: >2 days per week of symptoms, >1x/week of nighttime awakening, some limitation to normal activity and SABA use >2days/week

Very Poorly Controlled: symptoms throughout the day, nighttime awakening >1x/week, extremely limited activity and SABA several times per day

Question 11

Assessing Control in 5 and older (well, not well, very poorly controlled)

Answer 11

Well Controlled: symptoms = 2 days/week but not more than once each day, nighttime awakenings = 1x/month, no interference with normal activity, SABA =2 days/week
*FEV= >80%

Not Well Controlled: >2 days per week of symptoms, >/=2x/month of nighttime awakening, some limitation to normal activity and SABA use >2days/week
*FEV=60-80%

Very Poorly Controlled: symptoms throughout the day, nighttime awakening >/=2x/week, extremely limited activity and SABA several times per day
*FEV=<60%

Question 12

What indicates need to step up treatment? (2)

Answer 12

1. At 0-4 years old, no improvement with treatment after 4-6 weeks
2. At 12+, needing to use of SABA >2 days a week for symptom relief