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CMN 568 > Unit 3 Asthma > Flashcards

Unit 3 Asthma Flashcards

1
Q

Asthma oral corticosteroid dosage: children

A

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

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2
Q

Asthma oral corticosteroid dosage: adults

A

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

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3
Q

Asthma: treatment

STEP 1

A

(intermittent asthma)

all ages:
SABA prn

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4
Q

Asthma: treatment

STEP 2

A

(mild persistent)

all ages:
low dose ICS

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5
Q

Asthma: initial treatment

STEP 3

A

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

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6
Q

Asthma is characterized by:

A

bronchoconstriction
airway inflammation
reversible airflow limitation

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7
Q

strongest predictor of asthma

A

Atopy

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

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8
Q

Characteristics of Asthma Severity:
INTERMITTENT

Symptoms
Wakeups
SABA use
Activity problems

A

Symptoms: <2 days/week

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

SABA use: <2 days/week

Activity problems: none

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9
Q

Characteristics of Asthma Severity:
MILD PERSISTENT

Symptoms
Wakeups
SABA use
Activity problems

A

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

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10
Q

Characteristics of Asthma Severity:
MODERATE PERSISTENT

Symptoms
Wakeups
SABA use
Activity problems

A

Symptoms: daily

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

SABA use: daily

Activity problems: some

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11
Q

Characteristics of Asthma Severity:
SEVERE PERSISTENT

Symptoms
Wakeups
SABA use
Activity problems

A

Symptoms: throughout day

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

SABA use: several/day

Activity problems: very limited

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12
Q

Assessing Asthma Control:
WELL CONTROLLED

Symptoms
Wakeups
SABA use
Activity problems
Exacerbations requiring oral meds

Recommended action?

A

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)

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13
Q

Assessing Asthma Control:
NOT WELL CONTROLLED

Symptoms
Wakeups
SABA use
Activity problems
Exacerbations requiring oral meds

Recommended action?

A

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

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14
Q

Assessing Asthma Control:
VERY POORLY CONTROLLED

Symptoms
Wakeups
SABA use
Activity problems
Exacerbations requiring oral meds

Recommended action?

A

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

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15
Q

Asthma: treatment

STEP 4

A

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

> 5 y/o: medium dose ICS + LABA

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16
Q

Asthma: treatment

STEP 5

A

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

> 5 y/o: high dose ICS + LABA

17
Q

Asthma: treatment

STEP 6

A

high dose ICS + LABA + oral corticosteroid

18
Q

Asthma:

when to admit to hospital

A
  • 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
19
Q

Mild Asthma Exacerbation

A

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)
20
Q

Asthma: SABAs

A

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

21
Q

Asthma: Inhaled Corticosteroids (ICS)

A

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

-maximum response may not be observed for months

22
Q

Asthma: oral corticosteroids

A

most effective in achieving prompt control of asthma during exacerbations

23
Q

Asthma: LABA

A

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)

24
Q

Moderate Asthma Exacerbation

A

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

25
Q

Severe (Acute) Asthma Exacerbation

A
  • 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

CMN 568 (10 decks)

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