asthma therapeutic treatment algorithims

Question 1

2 classifications of asthma

Answer 1

Intermittent and persistent

Question 2

3 classifications of persistent asthma

Answer 2

Mild
Moderate
Severe

Question 3

Factors that classify asthma as intermittent

Answer 3

• 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

Question 4

factors that classify asthma as mild persistent

Answer 4

• 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

Question 5

factors that classify asthma as moderate persistent?

Answer 5

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

Question 6

factors that classify asthma as persistent asthma

Answer 6

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

Question 7

frequency of symptoms in intermittent asthma

Answer 7

less than or equal to 2x per week

Question 8

night time awakenings in intermittent asthma

Answer 8

less than or equal to 2x per month

Question 9

SABA use in intermittent asthma

Answer 9

less than or equal to 2 days/week

Question 10

lung function in intermittent asthma

Answer 10

everything normal

Question 11

exacerbations requiring oral steroids in intermittent asthma

Answer 11

0 or 1 / year

Question 12

frequency of symptoms in mild asthma

Answer 12

> 2 days per week

Question 13

nighttime awakenings in mild asthma

Answer 13

3-4 x/ month

Question 14

SABA use in mild asthma

Answer 14

> 2x per week, but not daily, and less than 1x per day

Question 15

exacerbations requiring oral steroids in mild asthma

Answer 15

2 or more times per year

Question 16

frequency of symptoms of moderate asthma

Answer 16

daily

Question 17

nighttime awakenings of moderate asthma

Answer 17

more than once a week

Question 18

SABA use of moderate asthma

Answer 18

Daily

Question 19

lung function of moderate asthma

Answer 19

FEV between 60 and 80 percent
FEV/FVC down 5%

Question 20

exacerbations requiring oral steroids in moderate asthma

Answer 20

2 or more per year

Question 21

frequency of symptoms in severe asthma

Answer 21

throughout the day

Question 22

nighttime awakenings in severe asthma

Answer 22

often, 7X/ week

Question 23

SABA use in severe asthma

Answer 23

several times per day

Question 24

interference with normal activity in severe asthma

Answer 24

extremely limited

Question 25

lung function in severe asthma

Answer 25

FEV less than 60% FEV/FVC down 5%

Question 26

exacerbations requiring oral steroids in severe asthma

Answer 26

2 or more per year

Question 27

algorithim to treat children 5 and under

Answer 27

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)

Question 28

algorithim to treat children 5 and under (alternate)

Answer 28

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)

Question 29

algorithim to treat 6 years and older

Answer 29

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

Question 30

Algorithm to treat 6 and older (alternate)

Answer 30

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

Question 31

three action plan assesments

Answer 31

green yellow red

Question 32

green assessment symptoms

Answer 32

No symptoms (little SOB, cough, wheezing, chest tightness or nighttime awakenings) can do usual activities peakflow>80% personal best

Question 33

Yellow assessment symptoms

Answer 33

Some symptoms peak flow 50-79%

Question 34

red assessment symptoms

Answer 34

Severe symptoms (SOB inhibiting walking or talking) - no improvement in SABA or >24 hrs in yellowpeak flow less than 50%

Question 35

green zone action plan

Answer 35

Continue maintenance inhalers albuterol before exercise trigger avoidance preventative therapy

Question 36

Yellow zone action plan

Answer 36

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

Question 37

asthma action plan red

Answer 37

Albuterol and oral steroid, give 15 minutes for responding and call ambulance

Question 38

first line of treatment for severe acute asthma

Answer 38

systemic corticosteroids inhaled albuterol epinephrine incase of anaphylaxis