Asthma part II Flashcards
Inhaled Corticosteriods
-anti-inflammatory
-one
-ide
Bronchodilators
relax smooth muscle in lungs
-Beta 2 agonists: -ol
-Anticholinergics: -ium, -rolate
true or false: 30-40% of asthma exacerbations lead to ED visits and death are in pts with severe asthma
False. mild asthma when treated with SABA alone
Why should you use an ICS in asthma?
-reduces inflammation
-improved asthma symptoms, exacerbations, hospitalizations, and risk of death
-reduce exposure to oral corticosteroids
SABA overuse
-relying on a SABA alone which can make it difficult to transition to ICS therapy later
-masks worsening symptoms
-does not address inflammation problem
Who does GINA recommend to receive ICS therapy?
-ALL adults and adolesants
-children 6-11
Anti-Inflammatory Reliever (AIR)
-therapy that alleviates symptoms and reduces inflammation
-ICS and SABA/LABA
-PRN medication
AIR therapy Step 1
-ICS-formoterol PRN (Symbicort)
-1 pull as needed typically
Max dose of ICS-formoterol in adults/adolesants
-Max total daily maintenance+ rescue dose of 54 mcg formoterol
-12 puffs Daily
Max dose of ICS-formoterol in children 5-11
-Max total daily maintenance+ rescue dose of 36mcg formoterol
-8 puffs Daily
Alternatives to Symbicort in AIR therapy
-Dulera: mometasone/formoterol
-most studies used symbicort so use clinical judgement
-Airsupra: budesonide/albuterol
Is ICS-formoterol FDA approved for rescue use?
no
Airsupra
-budesonide/albuterol
- >18 yrs
-1 puffs as NEEDED
-NOT a maintenance inhaler
Patient Activated Reliever Triggered ICS (PARTICS)
-patient takes their ICS each time they use their rescue inhaler
-alternative if patient can’t get combo products
GINA Guidelines 12+ Track 1
1-2: PRN low dose ICS formoterol
3: low dose MAINTENACE ICS-formoterol
4: medium dose MAINTENACE ICS-formoterol
5: add on LAMA and assess phenotype
-consider high dose ICS-formoterol
GINA Guidelines 12+ Track 2
1-take ICS whenever SABA is taken
2-low dose maintenance ICS
3-low dose MAINTENACE ICS-LABA
4- medium/high dose MAINTENACE ICS-LABA
5-add on LAMA and assess phenotype
-consider high dose ICS-formoterol
When do you ‘Step up’ therapy in GINA?
-when symptoms are poorly controlled despite good adherence, technique, ect
When do you step down in GINA?
-step down to achieve best asthma control with least exposure to medication side effects
Single Maintenance And Reliever Therapy (SMART)
-one inhaler as both maintenance and reliever therapy
-only ICS-formoterol can be used
-not FDA approved
LTRAs
-leukotriene receptor antagonists
-blocks inflammatory cascade by binding and BLOCKING leukotrienes in the airway
-less effective than ICS
Montelukast
-LTRA
-black box warning: metal side effects
-hepatic insufficiently and increase exposure
Zafirlukast
-serious hepatic adverse events
-contraindicated in hepatic impairment
Intermittent daily ICS
-for age 0-5
-7-10 days
-daily ICS after onset of symptoms
criteria for Intermittent ICS
> 3 wheezing episodes triggered by URI during lifetime OR
2 wheezing episodes in last year AND asymptomatic between periods of URI
How is NAEPP different from GINA?
-patients with INTERMITTENT are NOT provided ICS therapy
-SABA alone
-NO airsupra in NAEPP
Directly contradicts GINA
How long to wait to assess symptoms?
4 weeks
how long to wait to do med changes?
2-3 months
Stepping down considerations
-asthma should be well controlled for 3 months
-pt not traveling and should not have respiratory infection
Local ICS side effects
-pharyngitis
-Dysphonia
-Thrush
-sore throat
Systemic side effects of ICS
-suppressed growth
-osteoporosis
-skin thinning
-cataracts
-glaucoma
-HPA Axis suppression
-increased risk of pneumoniqa
treatment for thrush
-clotrimazole troches/lozenge 10 mg
-5x/day for 14 days
-Nystatin swish and swallow: 7-14 days
-Miconazole buccal tab:
