Module 4 - Asthma and Treatment

Question 1

Primary Prevention for Asthma

Answer 1

• vaginal delivery
• breast feeding
• no smoking
• no acetaminophen and broad spectrum abx use in first year of life

Question 2

Secondary Prevention for Asthma

Answer 2

None
- No screenings are available to screen for asthma

Question 3

Tertiary Prevention of Asthma

Answer 3

• Asthma Control Test (ACT)
• Asthma Therapy Assessment Questionnaire ( ATAQ)
• GINA Assessment

Question 4

Most Common Obstructive Lung Disease

Answer 4

1. COPD
2. Asthma

Question 5

• Step 1 Symptoms and Treatment for Asthma

Answer 5

symptoms less than twice a month? No

Track 1: PRN low dose ICS/Formoterol (1 inhaler)

Track 2: Low dose ICS daily and PRN ICS/SABA (two separate inhalers)

Question 6

• Step 2 Symptoms and Treatment for Asthma

Answer 6

symptoms twice or more a month
and/or symptoms < 4-5x week

Track 1: PRN low dose ICS/Formoterol (1 inhaler)

Track 2: Low dose ICS with PRN SABA

Question 7

• Step 3 Symptoms and Treatment for Asthma

Answer 7

symptoms most days
waking at least once a week from symptoms

Track 1: Low dose ICS /Formoterol as maintenance AND PRN (this is called MART)

Track 2: Low dose LABA/ICS as main and PRN SABA

Question 8

• Step 4 Symptoms and Treatment for Asthma

Answer 8

daily symptoms
waking at least once a week from symptoms
low lung function

Track 1: Medium dose ICS/Formoterol as maintenance AND PRN (this is called MART)

Track 2: Med or high dose ICS/LABA with PRN SABA

Question 9

Formoterol Onset

Answer 9

3-5 minutes

Question 10

• Other options step 2

Answer 10

low dose ICS + PRN SABA + ICS (two separate inhalers)

Question 11

• Other options step 4

Answer 11

switch to high dose ICS + LAMA or LTRA

Question 13

• Check Adherence with Asthma Meds

Answer 13

• poor adherence is very common
• contributory factors
  > unintentional: forgetfulness, confusion
  > intentional: perceived need, fear of s/e, cultural
  ** BOTH INCLUDE COST **
• use screening questions with low adherence

Question 14

Reviewing Response and Adjusting Treatment

Answer 14

Initiation: 1-3 mo after treatment, then every 3-12mo
Preggos: 4-6 weeks
After Exacerbation: 1 week

Question 15

• Assessing Asthma Severity

Answer 15

mild: controlled with step 1 or 2
- PRN SABA or low dose ICS
moderate: controlled with step 3
- low dose ICS/LABA
severe: controlled with step 4 or 5
- moderate or high dose ICS/LABA and add ons

Question 16

New Recommendations Regarding Treatment

Answer 16

• SABA is no longer recommended as preferred treatment for quick symptom relief
• Instead use PRN low dose ICS plus formoterol for rescue

Question 17

• Summary of Treatment

Answer 17

• start controlled treatment EARLY for best outcomes (as soon as diagnosis is made)

Question 18

• Indications for low dose ICS

Answer 18

even if one of the following:
- asthma symptoms more than twice a week
- waking due to asthma > that once a month
- any asthma symptoms plus any risk factors for exacerbation

consider starting at higher step if:
- troublesome asthma most days
- waking from asthma 1 or more x a week especially if any risk factors present

Question 19

Medication interactions with formoterol..?

Answer 19

ASA
NSAIDS
Sulfites
Monosodium Glutamate

Question 20

• Risk Factors

Answer 20

• house: dust mites
• diesel fuel exhaust
• exposure to irritants such as smoking
• change in weather
• strong emotions
• RESPIRATORY INFECTIONS
• NON ADHERENCE

Question 21

• Difference between PEF and FEV1

Answer 21

PEF: used to monitor asthma symptoms not COPD
will differ depending on day of symptoms
FEV1: used to monitor both. Mainly COPD

Question 22

which of the following is most effective way for patients with persistent asthma to monitor the severity of their symptoms

Answer 22

PEF

Question 23

asthma hx of 5 years complaints of sob 2 days. been using albuterol inhaler a bunch. unable to exercise. what diagnostic evaluation prior to initiation of treatment

Answer 23

PEF