Unit 3 Asthma

Question 1

Asthma oral corticosteroid dosage: children

Answer 1

1-2 mg/kg/day
either as a single daily dose or divided BID

maximum: 60 mg/day

(duration 3-10 days or until symptoms resolve)
no evidence that tapering dose of po steroids prevents relapse

Question 2

Asthma oral corticosteroid dosage: adults

Answer 2

40-60 mg/day
either as single dose or divided BID

(duration 3-10 days or until symptoms resolve)
no evidence that tapering dose of po steroids prevents relapse

Question 3

Asthma: treatment

STEP 1

Answer 3

(intermittent asthma)

all ages:
SABA prn

Question 4

Asthma: treatment

STEP 2

Answer 4

(mild persistent)

all ages:
low dose ICS

Question 5

Asthma: initial treatment

STEP 3

Answer 5

1-4 y/o: medium-dose ICS

5-11 y/o:
medium dose ICS
OR
low dose ICS + LABA/LTRA/theophylline

> 12 y/o:
medium dose ICS
OR
low dose ICS + LABA

Question 6

Asthma is characterized by:

Answer 6

bronchoconstriction
airway inflammation
reversible airflow limitation

Question 7

strongest predictor of asthma

Answer 7

Atopy

genetic tendency to develop allergic disease such as allergic rhinitis, asthma, and atopic dermatitis - eczema

Question 8

Characteristics of Asthma Severity:
INTERMITTENT

Symptoms
Wakeups
SABA use
Activity problems

Answer 8

Symptoms: <2 days/week

Wakeups:
<4y/o: 0
>5 y/o: <2x/month

SABA use: <2 days/week

Activity problems: none

Question 9

Characteristics of Asthma Severity:
MILD PERSISTENT

Symptoms
Wakeups
SABA use
Activity problems

Answer 9

Symptoms: >2 days/week

Wakeups:
<4y/o: 1-2x/month
>5 y/o: 3-4x/month

SABA use: >2 days/week

Activity problems: minor limits

Question 10

Characteristics of Asthma Severity:
MODERATE PERSISTENT

Symptoms
Wakeups
SABA use
Activity problems

Answer 10

Symptoms: daily

Wakeups:
<4y/o: 3-4x/month
>5 y/o: >1x/week

SABA use: daily

Activity problems: some

Question 11

Characteristics of Asthma Severity:
SEVERE PERSISTENT

Symptoms
Wakeups
SABA use
Activity problems

Answer 11

Symptoms: throughout day

Wakeups:
<4y/o: >1x/week
>5 y/o: 7x/week

SABA use: several/day

Activity problems: very limited

Question 12

Assessing Asthma Control:
WELL CONTROLLED

Symptoms
Wakeups
SABA use
Activity problems
Exacerbations requiring oral meds

Recommended action?

Answer 12

Symptoms: <2x/week

Wakeups:
0-4 y/o: <1x/month
5-11 y/o: <1x/month
>12 y/o: <2x/month

SABA use: <2x/week

Activity problems: none

Exacerbations requiring oral meds: 0-1/year

Recommended action?
MAINTAIN (f/u 1-6 months)

Question 13

Assessing Asthma Control:
NOT WELL CONTROLLED

Symptoms
Wakeups
SABA use
Activity problems
Exacerbations requiring oral meds

Recommended action?

Answer 13

Symptoms: >2x/week

Wakeups:
0-4 y/o: >1x/month
5-11 y/o: >2x/month
>12 y/o: 1-3x/week

SABA use: >2x/week

Activity problems: some limitation

Exacerbations requiring oral meds: 2-3/year

Recommended action?
Step up 1 step
Reevaluate 2-6 weeks

Question 14

Assessing Asthma Control:
VERY POORLY CONTROLLED

Symptoms
Wakeups
SABA use
Activity problems
Exacerbations requiring oral meds

Recommended action?

Answer 14

Symptoms: throughout the day

Wakeups:
0-4 y/o: >1x/week
5-11 y/o: >2x/week
>12 y/o: >4x/week

SABA use: several times each day

Activity problems: very limited

Exacerbations requiring oral meds: >3/year

Recommended action?
oral meds + step up 1-2 steps
reevaluate in 2 week

Question 15

Asthma: treatment

STEP 4

Answer 15

<4 y/o: medium dose ICS + LABA or montelukast

> 5 y/o: medium dose ICS + LABA

Question 16

Asthma: treatment

STEP 5

Answer 16

<4 y/o: high dose ICS + LABA or montelukast

> 5 y/o: high dose ICS + LABA

Question 17

Asthma: treatment

STEP 6

Answer 17

high dose ICS + LABA + oral corticosteroid

Question 18

Asthma:

when to admit to hospital

Answer 18

• poor response to SABA after 2 tx 20 min apart
• hypoxia (<95% RA)
• marked breathlessness: inability to speak in sentences
• use of accessory muscles
• changes in alertness
• PEF < 50% of personal best

Question 19

Mild Asthma Exacerbation

Answer 19

only minor changes in airway function, PEF>80%

• many respond to quick and fully inhaled SABA
• may need continuous SABA at increased dose
• can initiate inhaled corticosteroid if not taking or initiate po corticosteroid (doubling dose of po corticosteroid not effective)

Question 20

Asthma: SABAs

Answer 20

short acting beta agonists (bronchodilator)

-EROL (albuterol)

use: most effective bronchodilators - most effective during exacerbations
- relaxes smooth muscles to prompt increase airflow and decrease symptoms

Question 21

Asthma: Inhaled Corticosteroids (ICS)

Answer 21

preferred 1st line treatment agents for all patients w/ persistent asthma

-maximum response may not be observed for months

Question 22

Asthma: oral corticosteroids

Answer 22

most effective in achieving prompt control of asthma during exacerbations

Question 23

Asthma: LABA

Answer 23

should NOT be used as monotherapy b/c have no anti-inflammatory effects and linked to increased death risk (must be used w/ a corticosteroid)

Question 24

Moderate Asthma Exacerbation

Answer 24

goal of tx = correct hypoxemia w/ O2, reverse airflow obstruction, reduce occurrence of obstruction

• continue SABA
• early admin of corticosteroids (PO if peak flow <70% baseline or doesn’t respond to SABA)

-improvement of FEV1 after 30 minutes correlates to severity of asthma exacerbation

Question 25

Severe (Acute) Asthma Exacerbation

Answer 25

• immediate O2 keep sats >90%
• high dose SABA repeated
• PO corticosteroid
• IV Mg FEV1 <25%
• flu/pneumo vaccines

can DC home if PEF or FEV1 returns to >60%

contraindicated: mucolytics, respiratory depressants