Uncontrolled asthma, what to do?

Question 1

What groups hold the highest rates of uncontrolled asthma?

Answer 1

Girls, black children, young children 0-4 y, uninsured

Question 2

Questions to ask yourself when facing a pt w/ uncontrolled asthma

Answer 2

1. Is this really asthma?
2. Are the treatments working?
3. Are there unrecognized triggers?
4. Are there comorbidities?

Question 3

What approach do they recommend for uncontrolled asthma?

Answer 3

Assessing, adjusting and reviewing symptoms and risks to confirm Dx and implement interventions

Question 4

What does assessing involves?

Answer 4

Confirm Dx if necessary, ID symptom control, modifiable risk factors and comorbidities, check inhaler technique and adherence, and understand patient goals

Question 5

What does adjusting involves?

Answer 5

Tx of modifiable risk factors/comorbidities, management w/ nonpharmacologic therapies, Pt education and use of asthma medications

Question 6

What does reviewing involves?

Answer 6

Review response to tx, including symptoms, exacerbations, adverse effects, lung function and Pt satisfaction

Question 7

What are modifiable risk factors for uncontrolled asthma?

Answer 7

1. Other Dx besides asthma, 2. Adherence to Tx, 3. Inhaler technique, 4. Adverse effects of meds, 5. Environmental triggers (Allergies, tobacco, smoke exposure, pollution), 6. Comorbidities (Obesity, Reflux, Aspiration, Sinus disease) and 7. Age-specific concerns (esp in adolescence)

Question 8

What should a Pediatrician do about a pt w uncontrolled asthma?

Answer 8

Consider underlying factors and consider consulting with an Allergy or Pulmonary specialist

Question 9

What should a careful Hx include?

Answer 9

1. Environmental exposures (Pollutants, volatile chemicals, dust mites), 2. Living situation (smokers, pets, heat source), 3. Personal Hx allergies, 4. Family Hx allergies

Question 10

What can induce chronic inflammation and poorly controlled asthma?

Answer 10

Prolonged exposure to an inflammatory stimulus

Question 11

is the prevalence of uncontrolled asthma increasing or decreasing?

Answer 11

It seems to be increasing due to global warming issues and increasing levels of particulate matter in the air, especially in inner cities and developing countries

Question 12

Why is management improving?

Answer 12

Because there are increasingly specific therapeutic tools, more precise, more personal and tailored to the patient’s needs