Chronic Asthma- Severity, Symptom Control, Risk Factors for Exacerbation

Question 1

Assessing asthma severity: mild asthma

Answer 1

Controlled by Step 1 or 2 treatment

Question 2

Assessing asthma severity: moderate asthma

Answer 2

Controlled by Step 3 or 4 treatment

Question 3

Assessing asthma severity: severe asthma

Answer 3

Controlled by Step 5 treatment

Question 4

How is asthma severity assessed?

Answer 4

It’s assessed RETROSPECTIVELY from the level of treatment required to control symptoms and exacerbations

Question 5

When is asthma severity assessed?

Answer 5

After the patient has been on a controller treatment for several months

Question 6

True or false: the severity may change over months or years

Answer 6

True

Question 7

2 domains of asthma control

Answer 7

Symptom control and risk factors for exacerbation and poor outcomes

Question 8

Assessment of asthma control: how far back should you look at symptom control?

Answer 8

Last 4 weeks

Question 9

4 questions of GINA Assessment of Asthma Control

Answer 9

In the past 4 weeks, has the patient had…

Daytime asthma symptoms >2x/wk
Any night waking d/t asthma
Reliever (SABA) for symptoms >2x/wk (doesn’t count reliever used before exercise or if patient is taking Symbicort for reliever)
Any activity limitation d/t asthma

Question 10

Risk factors for asthma exacerbations: medications

Answer 10

ICS not prescribed
Poor adherence
Incorrect inhaler technique
High SABA use

Question 11

Risk factors for asthma exacerbations: comorbidities

Answer 11

obesity, chronic rhinosinutitis, GERD, food allergy, anxiety/MDD, pregnancy

Question 12

Risk factors for asthma exacerbations: exposures

Answer 12

Smoking, allergen exposure, air pollution

Question 13

Risk factors for asthma exacerbations: setting

Answer 13

Socioeconomic problems

Question 14

Risk factors for asthma exacerbations: lung function

Answer 14

low FEV1 (esp. if <60% predicted), higher reversibility

Question 15

Risk factors for asthma exacerbations: other factors

Answer 15

sputum/blood eos, elevated FENO in allergic adults on ICS, being intubated or in the ICU for asthma, having 1 or more severe exacerbations in the last 12 months

Question 16

Risk factors for poor asthma outcomes

Answer 16

Exacerbations, developing fixed airflow limitation, medication side effects

Question 17

Risk factors for developing fixed airflow limitation

Answer 17

Preterm birth/low birth weight
Lack of ICS Tx
Exposure to tobacco smoke, noxious chemicals, occupational exposures
Low FEV1
Chronic mucus hypersecretion
Sputum or blood eos

Question 18

Systemic medication side effects

Answer 18

frequent PO CS, long-term, high-dose and/or potent CS, taking P450is

Question 19

Local medication side effects

Answer 19

high-dose or potent ICS, poor inhaler technique

Question 20

If a patient is well controlled, how many “points” from the questionnaire do they have?

Answer 20

0

Question 21

If a patient is partly controlled, how many “points” from the questionnaire do they have?

Answer 21

1-2

Question 22

If a patient is uncontrolled, how many “points” from the questionnaire do they have?

Answer 22

3-4