Pulmonary conditions & tobacco cessation: Asthma Flashcards
Classic symptoms of asthma
breathlessness
wheezing
chest tightness
coughing
Common asthma triggers
Pollution
cigarettes
coldair/changes in weather
pets
dust/pollen
perfume
Drugs: aspirin, NSAIDs, beta-blockers
FEV1
how much air can be forcefully exhaled in 1 second
FVC
max volume of air exhaled after taking deep breath
FEV1/FVC
percent of total air that can be forcefully exhaled in 1 second
GINA Step 1
Daytime symptoms: < 2 X/month
Nighttime symptoms: none
GINA Step 2
Daytime symptoms > 2X/month, < 4-5 days/week
Night: none
GINA Step 3
Daytime symptoms: most days
Night: > 1/week
GINA Step 4/5
Daytime symptoms:daily
Night > 1/week
General asthma treatment approach
Start with which ever step based on symptoms
follow up 2-6 wks
counsel on appropriate technique
control risk factors
assess if need to step up therapy/down or maintain
once controlled can decrease visits 1-6 months
SABA…
short acting beta 2 agonist
ICS…
inhaled corticosteroid + relieved (formoterol preferred)
LABA….
Long acting beta 2 agonist
When are systemic steroids used in Asthma?
during exacerbations or severe asthma that is difficult to control
MART is…
maintenance and reliever therapy
Step 1 therapy
Rescue inhalers only:
As needed low-dose ICS-formoterol
or
SABA + low dose ICS
Step 2 therapy
Rescue: As needed low-dose ICS-formoterol
or
Rescue: SABA & Maintenance: Low dose ICS
Step 3 therapy
Rescue: Low dose ICS-formoterol & Maintenance same
or
Rescue: SABA + Maintenance: low dose ICS-LABA
Step 4 therapy
Rescue: Low dose ICS-formoterol & Maintenance: Medium dose ICS-formoterol
or
Rescue: SABA & Maintenance: Medium dose ICS-LABA
STEP 5 therapy
Rescue: Low dose ICS-formoterol & Maintenance: High dose ICS-formoterol
or
Rescue: SABA & Maintenance: High-dose ICS-LABA
Asthma variability of control
well = keep current therapy
Partly = Step up 1 step
Uncontrolled = Step up 1-2 steps, maybe short course oral steroid
SABA (albuterol) side effects
nervousness
tremor
tachycardia
palpitations
cough
hyperglycemia
decrease K
LABA (salmeterol = serevent) Boxed warnings
inc risk of asth related deaths, only use if not well controlled on ICS
inc risk of asthma related hhospitalizations
ICS warnings
high doses for long time can cause adrenal suppresion
inc risk of fractures, growth retardation and immunosuppression
ICS Side effects
Difficulty speaking
oral candidiasis = thrush
cough
ICS notes
rinse mouth with water and spit out after each use to prevent thrush, can use a spacer device to decrease risk
Which ICS doesnt need to be shaken before use?
Alvesco (ciclesonide)
Inhalers preferred for Asthma maintenance
ICS and ICS/LABA combo
Inhalers preferred for COPD maintenance
LABA,LAMA or LAMA/LABA
How to inhale a MDIs
slow, deep inhalation while pressing the canister
How to inhale DPIs
quick, forceful inhalation
Can you use spacer with DPI?
no
Do you shake DPI?
no, unlike MDI
Do you prime DPI?
no
Montelukas (Singulair) boxed warnings
neuropsychiatric events
LTRAs
Montelukas = LTD4
Zarfirlukast = LTD4 & LTE4
Zileuton = inhibit leukotriene formation
Montelukast notes
montelukast granules = can admin directly to mouth, dissolve in milk/applesauce/carrots/rice or ice cream ONLY, use within 15min of opening packet
Zafirlukast notes
dispense in original container
Use of Theophylline is due to…
limited decrease of effectiveness, drug interactions and adverse effects
Theophylline dosing
oral loading dose: 5mg/kg IBW
maintenance is 300-600mg/day
Theophylline levels
5-15 mcg/mil
Theophylline side effects
N/V/HA/insomnia
Toxicity = vomiting, arrhythmias, seizures
Aminophylline to théophylline conversion =
multiple by 0.8
Anticholinergics use in Asthma?
not used as stand alone therapy, usually add on treatments with ICS
Omalizumab (Xolair) boxed warnings
anaphylaxis from 1st dose up to 1yr after
Interleukin receptor antagonists are indicated for management of severe asthma with…..
eosinophilic phenotype
IL-5 receptor antagonists…..
Mepolizumab
reslizumab
benralizumab
IL-4 and IL-3 antagonists…
Dupilumab
Dupilumab (Dupixent) info
> 12yrs or older, given SC every other week
Benralizumab (Fasenra) info
> 12yrs or older, SC every 4 weeks for 3 doses, then Q 8 weeks
Reslizumab (Cinqair) info
adults only, IV Q 4 weeks
Mepolizumab (Nucala)
> 6yrs older, SC every 4 weeks
Preventing exercise induced bronchospasm
SABA or low-dose ICS + formoterol 5-15 min before exercise preferred
How long to wait inbetween inhalers if using more than 1?
60 seconds between each one
bronchodilators should be used first
Asthma action plan
Green = 80-100% personal best = all good continue maintenance
Yellow = 50-80% personal best = worsening lung function, caution.
Red = < 50% personal best = medical alert, go to ED
