Exam 3 Asthma Staging and Treatment Steps Flashcards
What frequency of SABA use would put a patient in the mild persistent asthma category regardless of age?
> 2 days per week but not daily
What frequency of SABA use would put a patient in the moderate persistent asthma category regardless of age?
Daily
If a patient is experiencing asthma symptoms daily, what category do they fall into?
Moderate persistent asthma
If a patient is experiencing asthma symptoms throughout the day, what category do they fall into?
Severe persistent asthma
If a patient is experiencing asthma symptoms up to 2 days a week, what category do they fall into?
Intermittent asthma
What percent of expected FEV1 would we expect a patient with intermittent or mild persistent asthma to have?
> 80% predicted FEV1
If a patient has <60% expected FEV1, what category do they fall into?
Severe persistent asthma
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?
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)
What asthma classification would someone fall in if they had nighttime awakenings twice a week?
In 0-4yo patients, this puts them in severe persistent asthma. In all other patients, this would be moderate persistent asthma.
If a patient has had one asthma exacerbation requiring oral systemic corticosteroids in the last year, what category do they fall in?
Intermittent asthma
In a 0-4 yo child with risk factors for asthma, what number of wheezing episodes per year would put them in persistent asthma?
Four or more wheezing episodes for year, all lasting >1 day
What step should you start at in intermittent asthma? What medications classes are in this step?
Step 1 – SABA prn
What step should you start at in mild persistent asthma? What medications are in this step?
Step 2 – Low dose ICS! An alternative would be cromolyn or montelukast or theophylline as a last resort.
What step should you start at in moderate persistent asthma? What medications are in this step?
Step 3 – Medium dose ICS
OR for pts >5yo, LOW-dose ICS + LABA or LTRA
What step should you start at in severe persistent asthma? What medications are in this step?
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
Under what conditions should you consider omalizumab (Xolair)?
Patients >12 yo with severe persistent and allergic asthma that is not well controlled. Usually administered at step 5.
Who should get a SABA?
Every asthma and COPD patient
Aside from medication, what other things do you want to do for your patients with asthma?
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.
If your patient’s symptoms fall into different staging categories, what category should you always treat to?
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.
In case of a moderate to severe exacerbation, what should a patient do?
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.
What dose of oral corticosteroids do we give adults? Children (0-11)?
Adults – PO prednisone 60mg daily x 3-10 days
Children – PO prednisone 1-2mg/kg/day x 3-10 days
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?
2 gm IV push
