Exam 3 Asthma Staging Practice Flashcards
A three year old girl has been experiencing wheezing and shortness of breath and needing to use her inhaler daily. Her mom tells you that her daughter has woken up wheezing twice in the last month. What type of asthma does she have? What is an appropriate drug regimen for her?
Moderate persistent asthma–daily symptoms and SABA use. Even though nighttime awakenings would put in mild.
Start at Step 3 – medium dose inhaled corticosteroids
>0.5-1mg daily dose of budesonide nebulizer solution (Pulmicort Respules) given once a day or in divided doses
OR
>176-352 mcg fluticasone (Flovent) HFA with spacer twice a day
I would choose Budesonide nebulizer solution 1mg/2mL given once a day if cost is not an issue with their insurance
A 8 year old boy comes in to the clinic. He tells you that every time he goes to baseball practice its hard for him to breathe when they practice running around the bases. He also can’t breathe well during recess and he wakes up almost every night struggling for breath. His teachers say that he has started to sit on the side of the playground by himself instead of playing with the others. What type of asthma does he have? What is an appropriate drug regimen for him?
Severe persistent asthma–symptoms throughout the day, nighttime awakenings almost every night, extremely limited ADL.
Start at step 3 or 4–I would start step 4.
Medium dose ICS + LABA or LTRA
Advair (fluticasone/salmeterol) 100mcg/50mcg, one inhalation BID
OR
Singulair (montelukast) 5mg chewable tablet at bedtime with Flovent (fluticasone) HFA 100mcg/puff BID
AND rescue inhaler (albuterol HFA 90mcg/puff)
I would choose the singulair/fluticasone combo because singular would help specifically control nighttime symptoms and is usually well tolerated whereas beta agonists can cause jitters and heart racing.
