bronchial asthma part 2

Question 1

how do we approach an asthma patient ?

Answer 1

asses 3 things :

Asses and confirm a diagnosis of asthma 
asses level of asthma control
asses triggers/comorbidities
adjust treatment 
review response

Question 2

how do we asses the control of asthma ?

Answer 2

yes/no questions from the past 4 weeks 
 all answered no ? well controlled keep treatment or step down 
1-2 yes answers ? partially controlled 
 3-4 yes answers ? uncontrolled
require further intervention

Question 3

what co morbidities can cause uncontrolled asthma

Answer 3

obesity
prregnancy
rhinitis
sinusitis
hypothyroidism
cardiac patients
GERD
Gastritis

Question 4

what is the approach to adjusting treatment ?

Answer 4

step 1 and 2 - symptoms less than 4-5 days a week
step 3 - symptoms wake the patient up at night
step 4 - daily symptoms with low lung function

Question 5

how often should the response to medication be reviewed ?

Answer 5

review every 2-3 months

Question 6

when can the medications be stepped down ?

Answer 6

once a good control is maintained for 3 months

Question 7

how do we asses acute exacerbations ?

Answer 7

1- asses severity
2- confirm diagnosis

Question 8

when would the patient need to be admitted to the ICU for mechanical ventilation?

Answer 8

silent chest 
confusion 
Low BP
RR less than 30 
So2 less than 90%

Question 9

how would you treat the acute exacerbation ?

Answer 9

administration of OCS , give some form of bronchodilator (SABA, SAMA)
correct the hypoxia with oxygen and keep the SO2 above 93

Question 10

if the patient wakes up with asthmatic symptoms what step is that ?

Answer 10

at least step 3

Question 11

what is the best treatment option for exercise induced asthma ?

Answer 11

prophylactic ICS- formeterol

Question 12

what medications are indicated in each step in asthma management ?

Answer 12

step 1 and 2 : as needed low dose formeterol

step 3 : maintenance low dose ICS-formeterol

Step4 : maintenance medium dose ICS-formetrol

step 5: add LAMA , consider high dose ICS-formetrol

Question 13

when can you discharge a patient that initially came with an acute exacerbation of asthma ?

Answer 13

symptoms improved
so2 above 94% on room air
PFT above 60-80% predicted