Patient Specific Considerations in Asthma

Question 1

Describe exercised induce bronchospasms(EIB)

Answer 1

airway narrowing as a result of physical activity

Question 2

Cause of EIB

Answer 2

increase in the amount of cold, dry air entering the airways

Question 3

Prevalence of EIB

Answer 3

-5-20% in general population
-90% of patients with SYMPTOMATIC asthma have EIB

Question 4

True or false: lower prevalence of EIB among athletes

Answer 4

False, up to 30-70%

Question 5

Characteristics of EIB

Answer 5

-poor asthma control
-can occur in pts with good asthma control
-can occur in pts without asthma

Question 6

When does EIB occur?

Answer 6

-2-5 min AFTER exercise
-peak at 10 min
-resolves around 60 min

Question 7

How do you treat EIB with poorly controlled asthma?

Answer 7

-5-20 minutes before exercise
-SABA: 2 inhalations
-budesonide-formoterol: 1 inhalations
-LTRA: 12 hour duration, take 2 hours before

Question 8

Effect of asthma on pregnancy

Answer 8

-increase pregnancy risks
-affects 8-14% of pregnant women
-symptoms worse in second trimester

Question 9

General rule for asthma in pregnancy

Answer 9

-1/3 get worse
-1/3 get better
-1/3 stable

Question 10

Should you withhold asthma medications in pregnancy?

Answer 10

NO
-risks of asthma are worse than risk of meds

Question 11

ICS therapy in pregnancy

Answer 11

-should be continued while attempting pregnancy and during pregnancy
do not attempt step down asthma therapy during pregnancy
-monitor ever 4-6 weeks
-asthma exacerbations should be managed aggressively

Question 12

Preferred asthma meds in pregnancy

Answer 12

-ICS: Budesonide or fluticason
-LABA: Salmeterol or Formoterol
-Biologics: limited data, Omalizumab has best evidence

Question 13

Non preferred asthma meds in pregnancy

Answer 13

Montelukast or Zarfirlukast

Question 14

Oral Corticosteriods in pregnancy

Answer 14

-potential for side effects: pre-ecalmpsia, oral clefts, low birth weight
-Avoid as maintence therapy but burst is preferred

Question 15

Addition considerations for asthma in pregnancy

Answer 15

–Use of ICS, SABA, LABA, theophylline, antihistamines, prednisone are OK with breastfeeding
-Influenza vaccine
-control environmental triggers
-STOP SMOKING

Question 16

Aspirin Exacerbated Respiratory(AER) Disease

Answer 16

-asthma, nasal polyps, acute exacerbations following use of NSAID or aspirin

Question 17

Clinical features of AER

Answer 17

-symptoms 30 min-3 hours following dose
-stuffy/waery nose, puffy eyes, wheezing, SOB,cough, chest tightness

Question 18

Treatment of AER disease

Answer 18

-aggressive treatment of asthma and sinus disease
-Absolute avoidance of aspiring and COX-1 NSAIDs
-need to give patients a list of safe drugs
0nasal corticosteriods
-LTRA with mod-severe asthma

Question 19

Persistent AERD

Answer 19

-biologics: dupilumab
-aspiring desensitization, followed by daily aspiring

Question 20

Weakly selective COX-1 inhibitors

Answer 20

-Acetaminophen
-Salsalate
-Diflunisal

Question 21

Highly selective COX2 inhibitors

Answer 21

-Celecoxib

Question 22

Preferentially selective COX-2 inhibitors

Answer 22

Mexoxicam

Question 23

ASA Desensitization

Answer 23

-uncontrolled respiratory symptoms despite optimal medical management
-Respiratory inflammatory disease
-multiple polyp surgeries
-requirement of asthma or treatment of other diseases