Term
|
Definition
- Wheezing most prominent on expiration
- Chronic dry cough
- Diagnosis of bronchitis
- Pneumonia not associated w/ infection |
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Term
| What is the most objective diagnosis criteria for asthma? |
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Definition
| Spirometry that is reversible |
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Term
| What are the clinical patterns of asthma? |
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Definition
- Intermittent - episodic illness w/ extended symptom free periods. Triggered by viral illness or allergens
- Chronic - Daily Sxs w/o symptom free periods
- Seasonal allergic - Daily Sxs during allergy season |
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Term
| How is asthma severity measured? |
|
Definition
- Frequency of sxs - SABA use
- Frequency of nocturnal sxs
- Spirometry results |
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Term
| What are the signs and symptoms of intermittent asthma? |
|
Definition
- Symptoms <2x/wk
- Asymptomatic between exacerbations
- Only awakened by symptoms twice a month
- FEV1 >= 80% |
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Term
| What are the signs and symptoms of mild persistent asthma? |
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Definition
- Symptoms more than twice a week, but only once a day
- Nighttime symptoms more than twice a month
- FEV >=80%, PEF variability 20-30
**May start to affect activity |
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Term
| What are the signs and symptoms of moderate persistent asthma? |
|
Definition
- Daily symptoms - daily SABA use
- Nighttime symptoms 1/week
- Activity affected 2x/week
- FEV1 60-80% |
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Term
| What are the signs and symptoms of severe persistent asthma? |
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Definition
Continual and limit physical activity w/ frequent nighttime symptoms.
FEV1 < 60%. Frequent = 4 out of 7 days |
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Term
| What classes of medications are used for LONG TERM control in asthma? |
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Definition
- Inhaled corticosteroids - Tx of choice for long term control
- LABAs
- leukotriene modifiers - bronchodilation and anti-inflammatory. Not for monotherapy
- Cromolyn - some evidence for exercise induced asthma |
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Term
| What is used to treat acute episodes of asthma? |
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Definition
| Short acting beta agonists |
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Term
| What medications are 'bronchodilators' for asthma? |
|
Definition
- Beta agonists - tx of choice for acute attacks
- Methylxanthines - does not relieve hyperresponsiveness
- Anticholinergics - if can't tolerate albuterol |
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Term
| What is the purpose of a spacer? |
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Definition
| Helps patients with difficulty using inhaler, reduces adverse effects |
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Term
| Is a nebulizer > an inhaler with a spacer? |
|
Definition
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Term
| What is an asthma action plan? |
|
Definition
How to recognize symptoms, medication benefits and side effects, proper use of inhalers and peak flow meters
** A peak flow meter assesses status. Use frequently, especially for severe patients. Severe - QAM and QHS, before meds and after exacerbations |
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Term
| What are indicators step up therapy is needed? |
|
Definition
- Sx at night
- Urgent care visits
- SABA use increase
- more than 1 canister of albuterol used/month |
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Term
| How is intermittent asthma(step 1) treated? |
|
Definition
- No long term control
- SABA used prn <= 2x/week
**same in children |
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Term
| How is mild persistent asthma treated? (Step 2) |
|
Definition
Low dose inhaled corticosteroids
**Same in children |
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Term
| How is moderate persistent asthma treated? (Step 3 and 4) |
|
Definition
ICS (low dose) + LABA
OR
ICS (med dose)
--> ICS (med dose) + LABA
**Children - 0-4 ICS med dose, 5-11: ICS (Med dose) or ICS (low dose) + LABA or LTM |
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Term
| How is severe persistent asthma treated? (steps 5 and 6) |
|
Definition
ICS (high dose) + LABA
AND
Consider addition of Omalizumab/Xolair for allergy patients.
Add a specialist!
Step 6: Tx of adults and youths >= 12: ICS (high dose) + LABA + oral corticosteroid
**Children: ICS (Med dose) + LABA or Singulair. Singulair is preferred in age 0-4. Step 5 proceed to ICS (high dose). Step 6 add corticosteroid. Cannot use Xolair in children. |
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Term
| What are indications of a severe attack? |
|
Definition
- breathless at rest
- Hunched forward
- Speaks words rather than complete sentences
- Agitated
- PEFR < 60%
**Management by O2 and beta agonists |
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Term
| What is used for exercise induced asthma? |
|
Definition
- SABA prior to exercise
- LABA prior to exercise - tolerance
- LTM - nonresponse
- Cromolyn - not as effective as SABAs |
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Term
| What asthma medications can be used in pregnancy? |
|
Definition
- Albuterol
- ICS - Budesonide/Pulmicort |
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Term
| What are adverse effects of ICS? |
|
Definition
Thrush - rinse mouth after use
Dysphonia, cough
**Takes 1-2 weeks to work |
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Term
|
Definition
Ciclesonide/Alvesco
Beclomethasone/Qvar
Budesonide/Pulmicort
Flunisolide/Aerobid
Fluticasone/Flovent
Mometasone/Asmanex
Triamcinolone/Azmacort
**ICS are the mainstay of tx! |
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Term
| What are adverse effects of LABAs in asthma? |
|
Definition
Tachycardia and tremor
Hypokalemia
DO NOT USE FOR ACUTE ATTACKS or as monotherapy |
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Term
|
Definition
Salmeterol/Serevent
Formoterol/Foradil
Arformoterol/Brovana |
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|
Term
| What are the adverse effects of high theophylline concentrations? |
|
Definition
Gastric upset and diarrhea
Tachycardia, seizures, hypokalemia |
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Term
| How is theophylline effected by 3A4 and 1A2 enzymes? |
|
Definition
- Increased clearance/decreased levels - phenytoin, rifampin, phenobarb, carbamazepine, smoking
- Decreased clearance/incr levels - cimetidine, erythromycin, clarith, zileuton, cipro, liver, CHF |
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Term
| What drugs are leukotriene modifiers? |
|
Definition
- Zileuton/Zyflo - HEPATOTOXICITY. take with high fat meals
- Zafirlukast/Accolate - HEPATOTOXICITY. Dose w/ food.
- Montelukast/Singulair - dose at bedtime |
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|
Term
| What drug is an IgE blocker? |
|
Definition
Omalizumab/Xolair
An adjunct in severe asthma, steps 5 and 6
** Dosing based on body weight, AE: anaphylaxis, injection site rxns |
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Term
| What drugs are short acting beta agonists? |
|
Definition
Albuterol/Proair or Ventolin
Levalbuterol/Xopenex
Pirbuterol/Maxair
Bitolterol/Tornalate |
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Term
| How are anticholinergics used for asthma? |
|
Definition
| - Ipratroprium - acute bronchospasm |
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Term
| When are systemic corticosteroids used for asthma? |
|
Definition
| For severe asthma flares - 60 mg is the max dose |
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|
Term
| What supplements can be used for asthma? |
|
Definition
- Vit C and E - no additional benefit to std tx
- Omega 3 and 6
- Decrease trans fatty acids
- Selenium
- Zinc
- Forskolin - inc cAMP
- Quercetin
**ICS are the mainstay of tx! |
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