asthma therapeutic treatment algorithims Flashcards
2 classifications of asthma
Intermittent and persistent
3 classifications of persistent asthma
Mild
Moderate
Severe
Factors that classify asthma as intermittent
- Frequency of symptoms ≤ 2 days/week
- nighttime awakenings ≤ 2x/ month
- SABA use ≤ 2 days/week
- no interference with normal activity
- Lung function- FEV > 80%
- exacerbations requiring oral steroids 0 or 1 / year
factors that classify asthma as mild persistent
- frequency of symptoms > 2 days/week
- nighttime awakenings- 3-4 / month
- SABA use- > 2 days / week but not daily and < 1 X/day
- minor interference with normal activity
- lung function- FEV1 >80%
exacerbations requiring oral steroids ≥ 2/year
factors that classify asthma as moderate persistent?
Frequency of symptoms- daily
nighttime awakenings > 1 X per week
SABA use- daily
interference with normal activity- some limitation
lung function- 60%<FEV<80%
FEV/FVC is down 5%
exacerbations requiring oral steroids≥2/year
factors that classify asthma as persistent asthma
frequency of symptoms- throughout the day
nighttime awakenings- 7x per week
SABA- several times per day
interference wiwth normal activity- extremely limited
Lung function>60 % of predicted
FEV/FVC reduced 5%
exacerbations requiring oral steroids ≥ 2/year
frequency of symptoms in intermittent asthma
less than or equal to 2x per week
night time awakenings in intermittent asthma
less than or equal to 2x per month
SABA use in intermittent asthma
less than or equal to 2 days/week
lung function in intermittent asthma
everything normal
exacerbations requiring oral steroids in intermittent asthma
0 or 1 / year
frequency of symptoms in mild asthma
> 2 days per week
nighttime awakenings in mild asthma
3-4 x/ month
SABA use in mild asthma
> 2x per week, but not daily, and less than 1x per day
exacerbations requiring oral steroids in mild asthma
2 or more times per year
frequency of symptoms of moderate asthma
daily
nighttime awakenings of moderate asthma
more than once a week
SABA use of moderate asthma
Daily
lung function of moderate asthma
FEV between 60 and 80 percent
FEV/FVC down 5%
exacerbations requiring oral steroids in moderate asthma
2 or more per year
frequency of symptoms in severe asthma
throughout the day
nighttime awakenings in severe asthma
often, 7X/ week
SABA use in severe asthma
several times per day
interference with normal activity in severe asthma
extremely limited
lung function in severe asthma
FEV less than 60%
FEV/FVC down 5%
exacerbations requiring oral steroids in severe asthma
2 or more per year
algorithim to treat children 5 and under
step1- none/SABA as needed for reliever
step 2- ICS low dose
step 3- If uncontrolled, double low dose ICS
step 4- controller and SABA
(LABA not used for children under 5)
algorithim to treat children 5 and under (alternate)
step1- n/a
step 2- leukotriene modifier or intermittent ICS
step 3- low dose ICS+ leukotriene modifier,
step 4- increase ICS frequency
(LABA not used for children under 5)
algorithim to treat 6 years and older
step 1- non controller, SABA prn
step 2- low dose ICS+ SABA prn
step 3- if 12 years or older, low ICS/LABA
if 6-11 years, medium dose ICS
SABA as reliever
step 4- med or high dose ICS
step 5- add tiotropium for 12 and older and antibody treatment
Algorithm to treat 6 and older (alternate)
Step 1- N/A
step 2- leukotriene modifier or theophyline if 12 and older (not recommended because of narrow therapeutic index and drug-drig interactions
step 3- Low ICS+ leukotriene modifier
or med/high ICS
step 4- add tiotropium or med/high ICS + leukotriene modifier
step 5- low dose oral corticosteroid
three action plan assesments
green yellow red
green assessment symptoms
No symptoms (little SOB, cough, wheezing, chest tightness or nighttime awakenings)
can do usual activities
peakflow>80% personal best
Yellow assessment symptoms
Some symptoms
peak flow 50-79%
red assessment symptoms
Severe symptoms (SOB inhibiting walking or talking)
- no improvement in SABA or >24 hrs in yellowpeak flow less than 50%
green zone action plan
Continue maintenance inhalers
albuterol before exercise
trigger avoidance
preventative therapy
Yellow zone action plan
take albuterol every 20 mins for 1 hour
IF symptoms and peak flow are in green zone, continue monitoring
if not, SABA + oral steroid bursts
call MD
asthma action plan red
Albuterol and oral steroid, give 15 minutes for responding and call ambulance
first line of treatment for severe acute asthma
systemic corticosteroids
inhaled albuterol
epinephrine incase of anaphylaxis
