Exam 3 Asthma Staging and Treatment Steps

Question 1

What frequency of SABA use would put a patient in the mild persistent asthma category regardless of age?

Answer 1

> 2 days per week but not daily

Question 2

What frequency of SABA use would put a patient in the moderate persistent asthma category regardless of age?

Answer 2

Daily

Question 3

If a patient is experiencing asthma symptoms daily, what category do they fall into?

Answer 3

Moderate persistent asthma

Question 4

If a patient is experiencing asthma symptoms throughout the day, what category do they fall into?

Answer 4

Severe persistent asthma

Question 5

If a patient is experiencing asthma symptoms up to 2 days a week, what category do they fall into?

Answer 5

Intermittent asthma

Question 6

What percent of expected FEV1 would we expect a patient with intermittent or mild persistent asthma to have?

Answer 6

> 80% predicted FEV1

Question 7

If a patient has <60% expected FEV1, what category do they fall into?

Answer 7

Severe persistent asthma

Question 8

If a 3 year old patient has nighttime awakenings twice a month, what category would he be in? What if the patient was 12 years old?

Answer 8

3 yo 2x a month –> Mild persistent
12 yo 2x a month –> Intermittent
(Classifications for 0-4 for nighttime awakenings are considered one step more severe than other patients)

Question 9

What asthma classification would someone fall in if they had nighttime awakenings twice a week?

Answer 9

In 0-4yo patients, this puts them in severe persistent asthma. In all other patients, this would be moderate persistent asthma.

Question 10

If a patient has had one asthma exacerbation requiring oral systemic corticosteroids in the last year, what category do they fall in?

Answer 10

Intermittent asthma

Question 11

In a 0-4 yo child with risk factors for asthma, what number of wheezing episodes per year would put them in persistent asthma?

Answer 11

Four or more wheezing episodes for year, all lasting >1 day

Question 12

What step should you start at in intermittent asthma? What medications classes are in this step?

Answer 12

Step 1 – SABA prn

Question 13

What step should you start at in mild persistent asthma? What medications are in this step?

Answer 13

Step 2 – Low dose ICS! An alternative would be cromolyn or montelukast or theophylline as a last resort.

Question 14

What step should you start at in moderate persistent asthma? What medications are in this step?

Answer 14

Step 3 – Medium dose ICS

OR for pts >5yo, LOW-dose ICS + LABA or LTRA

Question 15

What step should you start at in severe persistent asthma? What medications are in this step?

Answer 15

Step 3 for patients 0-4 – Medium dose ICS
Step 3 or 4 for patients 5-11 – low or medium dose ICS + LABA or LTRA or medium dose ICS alone
Step 4 or 5 for patients >12 – Medium or high dose ICS + LABA or LTRA

Question 16

Under what conditions should you consider omalizumab (Xolair)?

Answer 16

Patients >12 yo with severe persistent and allergic asthma that is not well controlled. Usually administered at step 5.

Question 17

Who should get a SABA?

Answer 17

Every asthma and COPD patient

Question 18

Aside from medication, what other things do you want to do for your patients with asthma?

Answer 18

Counsel on proper inhaler techniques, differentiate exacerbation meds vs control meds, develop an asthma action plan, keep updated on immunizations, follow up in 1-6 month intervals, and talk about eliminating triggers.

Question 19

If your patient’s symptoms fall into different staging categories, what category should you always treat to?

Answer 19

The most severe category. You can always step down therapy in 3 months if you need to, but you don’t want them to go undertreated.

Question 20

In case of a moderate to severe exacerbation, what should a patient do?

Answer 20

Take SABA, go to ED, likely will get a short course of systemic corticosteroids. In the case of a severe or life threatening exacerbation, ipratropium will be used as well.

Question 21

What dose of oral corticosteroids do we give adults? Children (0-11)?

Answer 21

Adults – PO prednisone 60mg daily x 3-10 days

Children – PO prednisone 1-2mg/kg/day x 3-10 days

Question 22

If an adult patient with asthma remains in a life-threatening exacerbation after one hour of hospital care, what dose of magnesium sulfate would you give them?

Answer 22

2 gm IV push