Chronic Asthma- Severity, Symptom Control, Risk Factors for Exacerbation Flashcards
Assessing asthma severity: mild asthma
Controlled by Step 1 or 2 treatment
Assessing asthma severity: moderate asthma
Controlled by Step 3 or 4 treatment
Assessing asthma severity: severe asthma
Controlled by Step 5 treatment
How is asthma severity assessed?
It’s assessed RETROSPECTIVELY from the level of treatment required to control symptoms and exacerbations
When is asthma severity assessed?
After the patient has been on a controller treatment for several months
True or false: the severity may change over months or years
True
2 domains of asthma control
Symptom control and risk factors for exacerbation and poor outcomes
Assessment of asthma control: how far back should you look at symptom control?
Last 4 weeks
4 questions of GINA Assessment of Asthma Control
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
Risk factors for asthma exacerbations: medications
ICS not prescribed
Poor adherence
Incorrect inhaler technique
High SABA use
Risk factors for asthma exacerbations: comorbidities
obesity, chronic rhinosinutitis, GERD, food allergy, anxiety/MDD, pregnancy
Risk factors for asthma exacerbations: exposures
Smoking, allergen exposure, air pollution
Risk factors for asthma exacerbations: setting
Socioeconomic problems
Risk factors for asthma exacerbations: lung function
low FEV1 (esp. if <60% predicted), higher reversibility
Risk factors for asthma exacerbations: other factors
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
Risk factors for poor asthma outcomes
Exacerbations, developing fixed airflow limitation, medication side effects
Risk factors for developing fixed airflow limitation
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
Systemic medication side effects
frequent PO CS, long-term, high-dose and/or potent CS, taking P450is
Local medication side effects
high-dose or potent ICS, poor inhaler technique
If a patient is well controlled, how many “points” from the questionnaire do they have?
0
If a patient is partly controlled, how many “points” from the questionnaire do they have?
1-2
If a patient is uncontrolled, how many “points” from the questionnaire do they have?
3-4
