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Mild Asthma in Preschoolers, Children & Adolescents > Mild Asthma in Preschoolers, Children & Adolescents > Flashcards

Mild Asthma in Preschoolers, Children & Adolescents Flashcards

1
Q

Definition of Asthma Severity

A

Is based on the level of treatment needed to maintain asthma control.
Severity can only be accurately determined when asthma is well controlled and adherence and correct inhaler technique have been accounted for

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2
Q

Age cut off for spirometry

A

6 years or older

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3
Q

Criteria for day time symptoms and need for reliever

A

less than or equal to 2 days a week

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4
Q

Definition of mild exacerbation

A

does not require

> systemic steroids,
an emergency department (ED) visit,
hospitalization.

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5
Q

Should you prescribe SABA only PRN for Very Mild/ Mild Asthma + Higher risk of exacerbation?

A

No

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6
Q

Young people considered at higher risk for exacerbation AND who need to be assessed for risk of exacerbation [beyond asthma severity]
are those who:

A

(1) Have any history of a previous severe
asthma exacerbation (i.e., requiring use of systemic steroids, or an
ED visit, or hospitalization);
(2) Have poorly controlled asthma;
(3) Over-use SABA (i.e., use more than two SABA
inhalers over a 1-year period); or
(4) Currently smoke. Passive exposure
to smoke and the inhalation of other substances (e.g., vaping,
cannabis)

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7
Q

Treatment of Asthma

A

1] Asthma Action Plan
2] Asthma Trigger Identification
3] Environmental Modifications Discussion
4] Treatment by Age + Severity

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8
Q

Very Mild Asthma, treatment required:

A

PRN SABA

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9
Q

Mild Asthma, treatment required:

A

Low-dose ICS (or LTRA) + PRN SABA or

PRN budesonide/formoterol

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10
Q

Moderate Asthma, treatment required:

A

Low-dose ICS + a second controller + PRN
SABA or

moderate doses of ICS +/− a second
controller
+ PRN SABA or

low-to-moderate-dose budesonide/
formoterol + PRN budesonide/formoterol

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11
Q

Severe Asthma, treatment required:

A

High-dose ICS + a second controller or

systemic
steroids for 50% of the previous year even if severe asthma is not controlled with this treatment

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12
Q

Preschooler [1 to 5 years] Doses Low

A

Beclomethasone
dipropionate HFA
(QVAR)…………………………….100

Budesonide*
(Pulmicort)………………………n/a

Ciclesonide*
(Alvesco)………………………..100

Fluticasone furoate*
(Arnuity)………………………….n/a

Fluticasone propionate
(Flovent, Aermony)………..<200

Mometasone furoate*
(Asthmanex)……………………n/a

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13
Q

Preschooler [1 to 5 years] Doses Medium

A

Beclomethasone
dipropionate HFA
(QVAR)…………………………….200

Budesonide*
(Pulmicort)………………………n/a

Ciclesonide*
(Alvesco)…………………………200

Fluticasone furoate*
(Arnuity)………………………….n/a

Fluticasone propionate
(Flovent, Aermony)…………………200-250

Mometasone furoate*
(Asthmanex)……………………n/a

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14
Q

Children [6 to 11 years] Doses Low

A

Beclomethasone
dipropionate HFA
(QVAR)………………………….≤200

Budesonide*
(Pulmicort)……………………≤400

Ciclesonide*
(Alvesco)……………………….≤200

Fluticasone furoate*
(Arnuity)………………………….n/a

Fluticasone propionate
(Flovent, Aermony)……………………..≤200

Mometasone furoate*
(Asthmanex)……………………100

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15
Q

Children [6 to 11 years] Doses Medium

A

Beclomethasone
dipropionate HFA
(QVAR)…………………..201 - 400

Budesonide*
(Pulmicort)……………..401 - 800

Ciclesonide*
(Alvesco)…………………201 - 400

Fluticasone furoate*
(Arnuity)………………………….n/a

Fluticasone propionate
(Flovent, Aermony)…201 - 400

Mometasone furoate*
(Asthmanex)…….≥200 to <400

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16
Q

Children [6 to 11 years] Doses High

A

Beclomethasone
dipropionate HFA
(QVAR)…………………………>400

Budesonide*
(Pulmicort)……………………>800

Ciclesonide*
(Alvesco)……………………….>400

Fluticasone furoate*
(Arnuity)…………………………n/a

Fluticasone propionate
(Flovent, Aermony)………..>400

Mometasone furoate*
(Asthmanex)………………….≥400

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17
Q

Adolescents & Adults [12 years and over] Doses Low

A

Beclomethasone
dipropionate HFA
(QVAR)………………………..≤200

Budesonide*
(Pulmicort)……………………≤400

Ciclesonide*
(Alvesco)……………………….≤200

Fluticasone furoate*
(Arnuity)……………………….100

Fluticasone propionate
(Flovent, Aermony)..≤250, 110

Mometasone furoate*
(Asthmanex)…………..100 - 200

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18
Q

Adolescents & Adults [12 years and over] Doses Medium

A

Beclomethasone
dipropionate HFA
(QVAR)……………………201 - 500

Budesonide*
(Pulmicort)……………..401 - 800

Ciclesonide*
(Alvesco)………………..201 - 400

Fluticasone furoate*
(Arnuity)……………………….n/a

Fluticasone propionate
(Flovent, Aermony)…………..251 – 500, 226

Mometasone furoate*
(Asthmanex)………..> 200 - 400

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19
Q

Adolescents & Adults [12 years and over] Doses High

A

Beclomethasone
dipropionate HFA
(QVAR)……………………….500 (max 800)

Budesonide*
(Pulmicort)…………………..> 800 (max 2,400)

Ciclesonide*
(Alvesco)……………………….>400 (max 800)

Fluticasone furoate*
(Arnuity)……………………….200 (max 200)

Fluticasone propionate
(Flovent, Aermony)……………………..>500 (max 2000)

Mometasone furoate*
(Asthmanex)…………………>400 (max 800)

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20
Q

Once daily dosing inhalers

A

Budesonide*
(Pulmicort)

Ciclesonide*
(Alvesco)

Fluticasone furoate*
(Arnuity)

Mometasone furoate*
(Asthmanex)

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21
Q

Low dose QVAR Preschoolers

A

Indication for
Beclomethasone
dipropionate HFA
(QVAR)

100

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22
Q

Medium dose QVAR in Preschoolers

A

Indication for
Beclomethasone
dipropionate HFA
(QVAR)

200

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23
Q

Low dose QVAR in Children, Adolescents and Adults

A

Indication for
Beclomethasone
dipropionate HFA
(QVAR)

≤200

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24
Q

Medium dose QVAR in Children

A

Indication for
Beclomethasone
dipropionate HFA
(QVAR)

201 - 400

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25
Q

High dose QVAR in Children

A

Indication for
Beclomethasone
dipropionate HFA
(QVAR)

> 400

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26
Q

Medium dose QVAR in Adolescents and Adults

A

Indication for
Beclomethasone
dipropionate HFA
(QVAR)

201 - 500

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27
Q

High dose QVAR in Adolescents and Adults

A

Indication for
Beclomethasone
dipropionate HFA
(QVAR)

500 - 800

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28
Q

Low dose Pulmicort in Children, Adolescents and Adults

A

Indication for Budesonide*
(Pulmicort)

≤400

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29
Q

Medium dose Pulmicort in Children, Adolescents and Adults

A

Indication for Budesonide*
(Pulmicort)

401–800

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30
Q

High dose Pulmicort in Children, Adolescents and Adults

A

Indication for Budesonide*
(Pulmicort)

> 800 to 2400

31
Q

Low dose Alvesco in Preschoolers

A

Indication for Ciclesonide*
(Alvesco)

100

32
Q

Medium dose Alvesco in Preschoolers

A

Indication for Ciclesonide*
(Alvesco)

200

33
Q

Low dose Alvesco in Preschoolers, Adolescents and Adults

A

Indication for Ciclesonide*
(Alvesco)

≤200

34
Q

Medium dose Alvesco in Preschoolers, Adolescents and Adults

A

Indication for Ciclesonide*
(Alvesco)

201–400

35
Q

High dose Alvesco in Adolescents and Adults

A

Indication for Ciclesonide*
(Alvesco)

> 400 to 800

36
Q

Low dose Arnuity in Adolescents and Adults

A

Indication for Fluticasone furoate*
(Arnuity)

100

37
Q

High dose Arnuity in Adolescents and Adults

A

Indication for Fluticasone furoate*
(Arnuity)

200 [Max]

38
Q

Low dose Flovent/ Aermony in Preschoolers

A

Indication for Fluticasone propionate
(Flovent, Aermony)

<200

39
Q

Medium dose Flovent/ Aermony in Preschoolers

A

Indication for Fluticasone propionate
(Flovent, Aermony)

200 - 250

40
Q

Low dose Flovent/ Aermony in Children

A

Indication for Fluticasone propionate
(Flovent, Aermony)

≤200

41
Q

Medium dose Flovent/ Aermony in Children

A

Indication for Fluticasone propionate
(Flovent, Aermony)

201 - 400

42
Q

High dose Flovent/ Aermony in Children

A

Indication for Fluticasone propionate
(Flovent, Aermony)

> 400

43
Q

Low dose Flovent/ Aermony in Adolescents and Adults

A

Indication for Fluticasone propionate
(Flovent, Aermony)

≤250, 110

44
Q

Medium dose Flovent/ Aermony in Adolescents and Adults

A

Indication for Fluticasone propionate
(Flovent, Aermony)

251–500, 226

45
Q

High dose Flovent/ Aermony in Adolescents and Adults

A

Indication for Fluticasone propionate
(Flovent, Aermony)

> 500 to 2000

46
Q

Low Asthmanex dose in Children

A

Indication for Mometasone furoate*
(Asthmanex)

100

47
Q

Medium Dose Asthmanex in Children

A

Indication for Mometasone furoate*
(Asthmanex)

≥200 to <400

48
Q

High Dose Asthmanex in Children

A

Indication for Mometasone furoate*
(Asthmanex)

≥400

49
Q

Low Dose Asthmanex in Adolescents and Adults

A

Indication for Mometasone furoate*
(Asthmanex)

100−200

50
Q

Medium Dose Asthmanex in Adolescents and Adults

A

Indication for Mometasone furoate*
(Asthmanex)

> 200–400

51
Q

High Dose Asthmanex in Adolescents and Adults

A

Indication for Mometasone furoate*
(Asthmanex)

> 400 to 800

52
Q

In well controlled asthma in preschoolers, children and adolescents

Daytime Symptoms

A

≤2 days per week

53
Q

In well controlled asthma in preschoolers, children and adolescents

Nighttime Symptoms

A

< 1 night per week and mild

54
Q

In well controlled asthma in preschoolers, children and adolescents

Physical Activity

55
Q

In well controlled asthma in preschoolers, children and adolescents

Exacerbations

A

Mild & Infrequent [i.e. does not negatively impact quality of life]

56
Q

In well controlled asthma in preschoolers, children and adolescents

Absence from work or school due to asthma

57
Q

In well controlled asthma in preschoolers, children and adolescents

Need for a reliever [SABA or bud/form]

A

≤2 doses per week

58
Q

In well controlled asthma in preschoolers, children and adolescents

FEV1 OR PEF

A

≥90% of personal best

59
Q

In well controlled asthma in preschoolers, children and adolescents

PEF diurnal variation

A

<10% to15%

60
Q

Age range with small decrease in growth rate with ICS daily use

[no - low impact longer-term max 1cm to 2cm decrease in final height]

A

5 - 15 years

61
Q

Age range in which bud/form is NOT recommended

62
Q

Rationale for prescribing ICS dosing everytime SABA is taken

A

Harm mitigation in adults ≥18 years old.

63
Q

Asthma Secondline Option

A

Daily leukotriene receptor antagonist
(LTRA) as an option for individuals of any age

64
Q

Side Effects of Leukotriene receptor antagonist
(LTRA)

A

Neuropsychiatric side
effects, most commonly irritability, aggressiveness, anxiety, and
sleep disturbance

65
Q

bud/form puffer approved for PRN use

A

200/6 mcg in adolescents

66
Q

PRN bud/form SIG

A

1 puff PRN to a maximum of
6 puffs on one occasion, or 8 puffs per day

Mild Asthma in Preschoolers, Children & Adolescents (1 decks)

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