Term
| albuterol (Proventil, Ventolin, ProAir) HFA MDI |
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Definition
Indication:
-quick relief of acute sx;
- prevention of EIBs;
Place in Therapy:
- DRUGS of CHOICE for acute bronchospasm;
- reg. scheduled use is NOT recommended;
- Increasing use, reg. use >2 days/wk or >1 canister/month indicates inadequate control unless pt is exercising each day;
MDI - 90 mcg/pf;
Adult Dose:
- 2 pf 5 min prior to exercise OR 2 pf q4-6 hrs PRN;
Child Dose:
- 1-2 pf 5 min prior to exercise OR 2 pf q4-6 hrs PRN;
May double usual dose for mild exacerbations; |
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Term
| levalbuterol (Xopenex) HFA MDI |
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Definition
Indication:
-quick relief of acute sx;
- prevention of EIBs;
Place in Therapy:
- DRUGS of CHOICE for acute bronchospasm;
- reg. scheduled use is NOT recommended;
- Increasing use, reg. use >2 days/wk or >1 canister/month indicates inadequate control unless pt is exercising each day;
MDI - 45 mcg/pf;
Adult Dose:
- 2 pf 5 min prior to exercise OR 2 pf q4-6 hrs PRN;
Child Dose:
- 2 pf q4-6 hrs PRN;
May double usual dose for mild exacerbations;
Approved for Children >=4 yrs old; |
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Term
| levalbuterol (Xopenex) nebulized soln |
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Definition
Indication:
-quick relief of acute sx;
- prevention of EIBs;
Place in Therapy:
- DRUGS of CHOICE for acute bronchospasm;
- reg. scheduled use is NOT recommended;
Dosage Form:
- Nebulization soln 0.31 mg/3 ml, 0.63 mg/3 ml, 1.25 mg/0.5 ml, 1.25 mg/3 ml;
Adult Dose:
- 0.63-1.25 mg q6-8 hrs PRN;
Child 0-4 yrs old Dose:
- 0.31-1.25 mg q4-6 hrs PRN;
Child 5-11 yrs old Dose:
- 0.31-0.63 mg q8 hrs PRN;
NOT FDA APPROVED for children <6 yrs old;
Supplied in sterile, preservative-free, unit dose vial |
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Term
| albuterol (Proventil, Accuneb) Nebulized soln |
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Definition
Indication:
-quick relief of acute sx;
- prevention of EIBs;
Place in Therapy:
- DRUGS of CHOICE for acute bronchospasm;
- reg. scheduled use is NOT recommended;
Dosage Form: 5 mg/mL OR Pre-mixed soln 0.63 mg/3 ml, 1.25 mg/3 ml, 2.5 mg/3 ml, 0.083%;
Adult Dose:
- 1.25-5 mg in 3 ml of saline q4-6 hrs PRN;
Child 0-4 yr old Dose:
- 0.63-2.5 mg in 3 mL of saline q4-6 hrs prn;
Child 5-11 yrs old Dose:
- 0.31-0.63 mg q4-8 hrs PRN;
May mix w/ cromolyn or ipratropium nebulizer solns;
May double usual dose for severe exacerbations; |
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Term
| ipratropium (Atrovent) HFA & Nebulized Soln |
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Definition
Indication:
- relief of acute bronchospasm;
- NOT FDA approved for asthma;
MoA:
- inhibits muscarinic cholinergic receptors --> bronchodilation;
- decreased mucus gland secretion;
Dosage Form: 17 mcg/pf MDI
Adult Dose: 2-3 pf q6 hrs;
Dosage Form: Nebulization Soln 0.25 mg/ml (0.025%)
Adult Dose: 0.25 mg q6 hrs
NO evidence of benefit with long-term use;
Dosing ONLY established in adults;
ADRs:
- dry mouth, blurred vision, may increase wheezing;
Place in Therapy:
- DRUG OF CHOICE for bronchospasm due to Beta-Blocker therapy;
- may provided added benefit to SABA
- alternative to pts intolerant to SABA;
- NOT effective for EIB |
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Term
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Definition
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Term
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Definition
ICS - Pulmicort Flexhaler
Dosing:
Children 0-4 yrs: N/A;
Children 5-11 yrs:
-Low Dose: 180-400 mcg;
-Medium Dose: >400-800 mcg;
-High Dose: >800 mcg;
Adult Dosing:
-Low Dose: 180-600 mcg;
- Medium Dose: >600-1,200 mg;
- High Dose: >1,200 mcg |
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Term
| budesonide nebulized soln |
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Definition
ICS - Pulmicort Respules
Dosing for Children:
Low Dose for 0-4 yrs: 0.25-5 mg;
Low Dose for 5-11: 0.5 mg;
Medium Dose for 0-4: >0.5-1.0 mg;
Medium Dose for 5-11: 1.0 mg;
High Dose for 0-4: >1.0 mg;
High Dose for 5-11: 2.0 mg; |
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
| prednisone (Deltasone, Prednisone Intensol) |
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Definition
Dosage Forms: 1, 2.5, 5, 10, 20, & 50 mg tabs, 5mg/ml & 5mg/5ml solutions;
Adult Dose:
- Short course "burst": 40-60 mg/d as a single or in 2 divided doses for 3-10 days;
- Long-term tx: 7.5 mg - 60 mg daily in a single dose in AM or every other day;
Child's Dosing:
- Short course "burst": 1-2 mg/kg/day, divided into 1-4 doses. Max of 60 mg/d for 3-10 days;
- Long-term Tx: 0.25-2 mg/kg daily in a single dose in AM or every other day; |
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Term
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Definition
DPI 12 mcg/single use capsule;
Adult Dose:
- 1 capsule (inhaled) q12 hrs;
- in EIB: 1 capsule (inhaled) 15 min prior to exercise;
Child Dosing (for child >=5 yrs):
- 1 capsule inhaled q12 hrs;
- for EIB: 1 capsule inhaled 15 min prior to exercise; |
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Term
| theophylline (Theo-24, Elixophyllin, Theocron) |
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Definition
Place in Therapy:
- alternative tx for mild persistent asthma;
- alternative adjunct therapy with ICS;
- last resort for most patients;
Dosage Forms: liquids, SR caps & tabs;
Adult Dose:
- 10 mg/kg/day up to 300 mg MAX. Titrate to response & serum level of 5-15 mcg/mL. MAX dose: 800 mg/day;
Child's Dosing:
- 10 mg/kg/day. Titrate to response & serum level of 5-15 mcg/mL. MAX dose for peds >= 1 yr: 16 mg/kg/day; |
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Term
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Definition
Place in Therapy:
- alternative for tx of mild persistent asthma;
- useful for exercise or known allergen-induced bronchospasm;
Indication:
- long-term prevention of sx;
- preventative tx prior to exposure to exercise or known allergen;
MoA: anti-inflammatory, inhibits acute response to exercise, cold air, or sulfur dioxide;
Dosage Form: MDI (CFC) 1 mg/pf, nebulization soln 20 mg/ampule;
Adult Dose:
- 2 pf QID or 1 ampule QID;
Child Dose:
0-4 yrs: 1 pf QID;
5-11 yrs: 2 pf QID;
Nebulized Soln (>=2 yrs): 1 ampule QID |
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Term
|
Definition
Leukotriene receptor antagonist;
Indication:
- prophylaxis & chronic tx of asthma in pts >12 months of age;
- acute prevention of EIB in pt >=5 yrs;
Place in Therapy:
- alternative option for mild persistent asthma or adjunct therapy w/ ICS;
Dosage Forms:
- 4 mg granule packet, 4 or 5 mg chewable tab, 10 mg tab;
Adult Dose:
- 10 mg qHS;
Child Dosing:
1-5 yrs: 4 mg qHS;
6-14 yrs: 5 mg qHS;
>14 yrs: 10 mg qHS;
Dissolve granules in tsp of cold or room temp baby formula or breast milk, or mixed with applesauce, carrots, rice or ice cream;
ADRs:
- URTI, HA, abdominal pain, neuropsychiatric events |
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Term
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Definition
Place in Therapy:
- adjunct in pts who have allergies & severe persistent asthma that is inadequately controlled w/ ICS
Indication: long-term control & prevention of sx in adults >=12 yrs old w/ moderate or severe persistent asthma inadequately controlled on ICS;
MoA:
- recombinant anti-IgE Ab, binds to Fc portion of IgE --> decreases release of inflammatory mediators; decreases # of IgE receptors on basophils;
Clnical Effects:
- reduction in exacerbations;
- improvement in lung fcn;
- allows for reduction in steroid dose;
- improvement in quality of life scores;
Dosing:
- 150-375 mg SC q2-4 wks
ADRs:
BBW - Anaphylactic Rxns
- injection-site pain & burning, malignancy |
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Term
| fluticasone/salmeterol (Advair Diskus & HFA) |
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Definition
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Term
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Definition
| a chronic inflammatory disorder of the airways involving many cellular elements (mast cells, eosinophils, T-cells, etc) that is characterized by recurrent episodes of wheezing, breathlessness, chest tightness, and cough; Associated with airflow obstruction that is often REVERSIBLE spontaneously or with tx; Results in increase in existing bronchial hyperresponsiveness to stimuli |
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Term
| Host Factors involved with Asthma |
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Definition
Innate Immunity ("hygiene hypothesis") - imbalance between Th1 & Th2 lymphocytes: results in decrease in infection, decrease exposure to other children, increase in antibiotic use;
Genetics - atopy is a significant risk factor, strongest indicator of persistence in adulthood |
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Term
| Environmental Factors involved in Asthma |
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Definition
Allergens: dust mites, Alternaria, animal dander, cockroaches;
Respiratory infections: RSV, influenza, parainfluenza, rhinovirus;
Other exposures: tobacco smoke, air pollution, occupation, diet low in antioxidants and omega-3 fatty acids |
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Term
| Key Indicators for Diagnosis of Asthma |
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Definition
Wheezing;
Hx of: cough, recurring wheezing episodes, recurrent difficulty breathing, recurrent chest tightness;
Sx worsen in presence of:
- exercise, viral infection, animals, dust mites, mold, pollen, smoke, airborne chemicals, changes in weather, strong emotional expression, menses;
Symptoms occur or WORSEN at night |
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Term
| Pulmonary Function Tests (PFTs - spirometry) |
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Definition
used in diagnosis & monitoring of asthma to assess presence, severity, and reversibility of airflow obstruction;
RECOMMENDED in ALL pts >=5 yrs old;
Performed before AND after SA bronchodilator;
Measures: FEV1 & FVC |
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Term
| FEV1 - Forced Expiratory Volume in 1 second |
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Definition
| volume of air that is forcibly exhaled in 1 second |
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Term
| FVC - Forced Vital Capacity |
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Definition
| max volume of air forcibly exhaled after maximal inhalation |
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Term
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Definition
| reduction in FEV1/FVC belwo 5th percentile of predicted value |
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Term
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Definition
| increase in FEV1 of >200 mL and/or >=12% from baseline after inhalation of SA bronchodilator |
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Term
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Definition
Symptoms <=2 days/wk;
Night-time Awakenings <=2x/month;
SABA use for sx control <=2 days/wk;
Interference w/ Normal Activity: NONE;
Lung Function:
- normal FEV1 b/w exacerbations;
- FEV1 >80% predicted;
- FEV1/FVC is normal; |
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Term
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Definition
Symptoms >2 days/wk, but not daily;
Nighttime Awakenings 3-4x/month;
SABA use: >2 days/wk but not daily, & not more than 1x on any day;
Interference w/ Normal Activity: minor limitation;
Lung Function:
- FEV1 >80% predicted;
- FEV1/FVC normal |
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Term
| Moderate Persistent Asthma |
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Definition
Symptoms: Daily;
Nighttime Awakenings: >1x/wk but not nightly;
SABA use: daily;
Interference w/ normal activity: Some limitation;
Lung Function:
- FEV1 >60% but <80% predicted;
- FEV1/FVC reduced 5% |
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Term
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Definition
Symptoms: throughout day;
Nighttime Awakenings: often 7x/wk;
SABA use: several times per day;
Interference w/ Normal Activity: Extremely limited;
Lung Function:
- FEV1 <60% predicted;
- FEV1/FVC reduced >5% |
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Term
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Definition
Reduce Impairment: prevent chronic & troublesome sx, require infrequent use of SABA, maintain normal pulmonary fcn, maintain normal activity levels;
Reduce Risk: prevent recurrent exacerbations & ED or hospitalizations, prevent loss of lung fcn, provide optimal pharmacotherapy w/ minimal or no SEs |
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Term
| Short-Acting Beta-2 Agonists (SABA) - albuterol (ProAir, Ventolin, Proventil, Accuneb), pirbuterol (Maxair), terbutaline (Brethaire, Brethine), metaproterenol (Alupent) |
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Definition
Indication:
-quick relief of acute sx;
- prevention of EIBs;
Place in Therapy:
- DRUGS of CHOICE for acute bronchospasm;
- reg. scheduled use is NOT recommended;
- Increasing use, reg. use >2 days/wk or >1 canister/month indicates inadequate control unless pt is exercising each day;
Onset of Action: 3-5 min;
SEs: tachycardia, skeletal muscle tremor, hypokalemia, hyperglycemia, increased lactic acid, HA; |
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Term
| Inhaled Corticosteroids (ICS) - beclomethasone (QVAR), budesonide (Pulmicort Flexhaler, Respules), flunisolide (Aerobid, Aerobid-M, Aerospan), fluticasone (Flovent HFA, Diskus), mometasone (Asmanex) |
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Definition
Place in Therapy:
- most potent & consistently effective long-term control medication
Indication:
- long-term prevention of sx by suppression, control, & reversal of inflammation;
- reduce need for systemic corticosteroids;
MoA:
- Anti-inflammatory: blocks late rxn & reduces airway hyperresponsiveness;
- inhibits microvascular leakage;
- reverse beta-2-receptor downregulation;
Clinical Effects:
- reduction in severity of symptoms;
- improvement in peak expiratory flow (PEF) & spirometry;
- diminished airway hyperresponsiveness;
- prevetion of exacerbations;
- reduction in systemic corticosteroid use, ED care, hospitalizations, & death; |
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Term
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Definition
| cough, dysphonia, oral thrush, growth suppression, systemic effects (adrenal suppression, osteoporosis, skin thinning & easy bruising, cataracts & glaucoma) |
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Term
| Strategies to Reduce Adverse Effects of ICS |
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Definition
use spacer with MDIs;
rinse mouth & spit after use;
use lowest necessary dose to maintain asthma control;
Monitor growth in children;
Consider Ca & Vit. D supplementation |
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Term
| Systemic Corticosteroids - methylprednisolone (Medrol), prednisolone (Prelone, Pediapred, Orapred, Orapred ODT), prednisone (Deltasone, Prednisone Intensol), methylprednisolone acetate (Depo-Medrol) |
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Definition
Indication:
-short-term burst (3-10 days) to gain prompt control of inadequately controlled persistent asthma;
- long-term prevention of sx in severe persistent asthma;
Short-term "Burst": continue until sx resolve & PEF is >=80% of personal best;
Long-term tx: Administerd in AM daily or on alternate days - may consider 3 PM dosing to decrease adrenal suppression if daily dose is required;
Use at lowest effective dose |
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Term
| Side Effects of Systemic Corticosteroids |
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Definition
Short-term Use:
- abnormalities in blood glucose, increased appetite, fluid retention, weight gain, facial flushing, mood alteration, hypertension, peptic ulcer;
Long-term Use:
- ADRENAL SUPPRESSION, GROWTH SUPPRESSION, osteoporosis, thinning of skin, HTN, DM, Cushingoid appearance, cataracts, myopathy, impaired immune fcn |
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Term
| Long-Acting Beta-2-Agonists - salmeterol (Serevent), formoterol (Foradil) |
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Definition
Place in Therapy:
- PREFERRED ADJUNCT with ICS for long-term control of sx;
- NOT recommended for use as monotherapy;
- NOT recommended to tx acute symptoms or exacerbations;
Indications:
- long-term prevention of sx IN ADDITION to anti-inflammatory therapy;
- prevention of EIB;
PKs:
- Onset: 5-20 min;
- Duration: >12 hrs;
Clinical Effects:
- reduction in sx;
- reduction in exacerbations;
- reduction in use of SABA;
ADRS:
- BBW: increased risk of severe, life-threatening exacerbations;
- tachycardia, skeletal muscle tremor, hypokalemia, hyperglycemia; |
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Term
| Methylxanthines - theophylline (Theo-24, Elixophyllin, Theochron) |
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Definition
Indication:
- long-term control & prevention of sx in mild persistent asthma or as ADJUNCT therapy w/ ICS in moderate-severe persistent asthma;
MoA: nonselective PDE inhibitor, also increases diaphragm contractility & mucociliary clearance;
Clinical Effects:
- improves lung fcn; |
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Term
| Monitoring Theophylline Levels |
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Definition
Therapeutic Range: 5-15 mcg/mL;
Check level in middle of dosing interval:
- BID dosing: 3-7 hrs after dose;
- Daily dosing: 8-12 hrs after dose;
Steady State is reached in 3-5 days; |
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Term
| ADRs of Theophylline at Therapeutic Doses |
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Definition
insomnia;
GI upset;
aggravation of ulcer or GERD;
increased hyperactivity in children;
difficulty urinating in elderly males with prostatism |
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Term
| ADRs of Theophylline Toxicity |
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Definition
| tachycardia; N/V; hypokalemia; hyperglycemia; HA; CNS stimulation; cardiac tachyarrhythmias; seizures |
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Term
| Drugs that DECREASE theophylline Levels |
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Definition
| phenobarbital, phenytoin, carbamazepine, rifampin, smoking |
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Term
| drugs that INCREASE theophylline levels |
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Definition
| allopurinol, cimetidine, macrolide antibiotics, quinolone antibiotics, ticlopidine |
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Term
| Mast Cell Stabilizer - cromolyn (Intal) |
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Definition
Place in Therapy:
- alternative for tx of mild persistent asthma;
- useful for exercise or known allergen-induced bronchospasm;
Indication:
- long-term prevention of sx;
- preventative tx prior to exposure to exercise or known allergen;
MoA: anti-inflammatory, inhibits acute response to exercise, cold air, or sulfur dioxide;
Clnical Effects:
- reduces sx;
- prevents exacerbations;
- strong safety profile;
ADRs:
- cough, wheeze; |
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Term
| Stepwise Approach for Managing Asthma in Children 0-4 yrs Old |
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Definition
Step 1 (Intermittent Asthma):
Preferred: SABA PRN;
Persistent Asthma (Steps 2-6) - always have SABA PRN for symptoms:
Step 2 - Preferred: Low-dose ICS;
Step 3 - Preferred: Medium-dose ICS;
Step 4 - Preferred: Medium-dose ICS + either LABA OR montelukast;
Step 5 - Preferred: High-dose ICS + either LABA OR montelukast;
Step 6 - Preferred: High-dose ICS + either LABA or montelukast AND oral systemic corticosteroids |
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Term
| Stepwise Approach for Managing Asthma in Children 5-11 yrs |
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Definition
Step 1 (Intermittent Asthma):
Preferred: SABA PRN;
Persistent Asthma (Steps 2-6) - always have SABA PRN for symptoms:
Step 2 - Preferred: Low-dose ICS;
Step 3 - Preferred: EITHER Medium-dose ICS OR Low-dose ICS + LABA, LTRA, or theophylline;
Step 4 - Preferred: Medium-dose ICS + either LABA;
Step 5 - Preferred: High-dose ICS + either LABA;
Step 6 - Preferred: High-dose ICS + LABA + oral systemic corticosteroids |
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Term
| Stepwise Approach for Managing Asthma in Adults (>=12 yrs) |
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Definition
Step 1 (Intermittent Asthma):
Preferred: SABA PRN;
Persistent Asthma (Steps 2-6) - always have SABA PRN for symptoms:
Step 2 - Preferred: Low-dose ICS;
Alternative: Cromolyn, LTRA, or theophylline;
Step 3 - Preferred: EITHER Medium-dose ICS OR Low-dose ICS + LABA;
Alternative: Low-dose ICS + either LTRA, theophylline, or zileuton;
Step 4 - Preferred: Medium-dose ICS + either LABA;
Alternative: Medium-dose ICS + either LTRA, theophylline, or zileuton;
Step 5 - Preferred: High-dose ICS + either LABA AND consider omalizumab for pts who have allergies;
Step 6 - Preferred: High-dose ICS + LABA + oral systemic corticosteroids AND consider omalizumab for pts who have allergies; |
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Term
| Well Controlled Asthma in Adults |
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Definition
Symptoms <=2 days/wk;
Nighttime Awakenings <= 2x/month;
Interference w/ normal activity: NONE;
SABA use for symptom control: <=2 days/wk;
FEV1 >80% predicted;
Validated Questionnaires:
ATAQ - 0
ACQ - <= 0.75
ACT - >= 20 |
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Term
| Recommended Action for Well Controlled Asthma in 0-4 yr olds, 5-11 yr olds, & >=12 & adults |
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Definition
Maintain current therapy;
Regular follow up in 1-6 months;
Consider step down if well controlled for at least 3 months. |
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Term
| Not Well Controlled Asthma in Adults |
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Definition
Symptoms >2 days/wk;
Nighttime Awakenings 1-3x/wk;
Interference w/ normal activity: Some Limitation;
SABA use: >2 days/wk;
FEV1 60-80% predicted;
Validated Questionairres:
ATAQ - 1-2
ACQ - >=1.5
ACT - 16-19 |
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Term
| Recommended Action for Not Well Controlled Asthma in 0-4 yr olds, 5-11 yr olds, & adults |
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Definition
Step up 1 Step;
Reevaluate in 2-6 wks;
If no clear benefit, consider alternative diagnoses or adjusting therapy;
For side effects, consider alternative tx options; |
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Term
| Recommended Action for Very Poorly Controlled Asthma in 0-4 yr olds, 5-11 yr olds, & adults |
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Definition
Consider short course of oral systemic corticosteroids;
Step up (1-2 steps), and reevaluate in 2 wks;
If no clear benefit in 4-6 weeks, consider alternative diagnoses or adjusting therapy;
For side effects, consider alternative options; |
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Term
| Very Poorly Controlled Asthma in Adults |
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Definition
Symptoms: throughout day;
Nighttime awakening: >=4x/wk;
Interference w/ Normal Activity: Extremely limited;
SABA use: several times per day;
FEV1 <60% predicted value;
Validated Questionaires:
ATAQ - 3-4
ACQ - N/A
ACT - <= 15 |
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Term
| Stepwise Approach for Managing Asthma |
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Definition
1) Determine classification of severity;
2) Select tx that corresponds to pt's level of severity;
3) Determine level of control & adjust therapy; |
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Term
| Monitoring to Assess Asthma Control |
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Definition
| Signs & Symptoms; Pulmonary Fcn; Quality of Life; Hx of Asthma Exacerbations; Pharmacotherapy; Pt-Provider Communication & Pt Satisfaction; |
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Term
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Definition
symptoms;
peak-flow monitoring;
daily diary;
self-assessment questionnaire |
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Term
| Written Asthma Action Plan |
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Definition
written instructions for daily management & recognizing & responding to worsening asthma control;
Recommended for ALL pts;
Based on symptoms, peak flow monitoring, or both;
Green: 80-100% - Doing Well;
Yellow: 50-70% - Asthma is getting worse;
Red: <50% - Medical Alert; |
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Term
| Using Metered-Dose Inhaler (MDI) |
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Definition
1) take off cap & shake inhaler;
2) breathe out all the way;
3) hold inhaler how MD told you to;
4) Start breathing in slowly, press down on inhaler first time;
5) Keep breathing slowly, as deeply as you can;
6) Hold breath as you count to 10 slowly;
7) For inhaled quick-relief medicine, wait about 15-30 sec between puffs |
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Term
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Definition
1) move indicator to bottom of numbered scale;
2) Stand up;
3) Take a deep breath, filling lungs completely;
4) Place mouthpiece in your mouth & close your lips around it. Do not put tongue inside the hole;
5) Blow out as hard and fast as you can in a single blow; |
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