Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
36 Cards in this Set
- Front
- Back
|
What are the components used to determine asthma severity
|
Lung function (FEV1 and FEV1/FVC ratio)
symptoms nighttime awakening use of SABA for control (not prvt) interference with normal activities Risk |
|
|
What is normal FEV1/FVC for an 8-19yo?
|
85%
|
|
|
What is normal FEV1/FVC for a 20-39yo?
|
80%
|
|
|
What is normal FEV1/FVC for a 40-59yo?
|
75%
|
|
|
What is normal FEV1/FVC for a 60-79yo?
|
70%
|
|
|
What are the classifications of asthma severity
|
1. intermittent
2. persistent: a. mild persistent b. moderate persistent c. severe persistent |
|
|
How often are symptoms in each of the classifications of asthma
|
intermittent: 2 or fewer x/wk
mild pers: >2x/wk mod pers: daily severe pers: throughout the day |
|
|
How often are night-time awakenings in each of the classifications of asthma
|
intermittent: 2 or fewer nights/mo
mild: 3-4 nights/ mo moderate: more than weekly severe: every night |
|
|
How often are SABAs used for control in each of the classifications of asthma
|
intermittent: 2 or fewer x/week
mild: >2x/wk moderate: daily severe: through day |
|
|
How much does asthma interfere with life in each of the classifications of asthma
|
intermittent: none
mild: mild limitations moderate: some limitation severe: extreme limitations |
|
|
What are the lung function levels in each of the classifications of asthma
|
intermittent and mild persistent: FEV1: >80% predicted
moderate persistent: FEV1 60-80% predicted; FEV1/FVC decreased by 5% severe persistent: FEV1 <60%; FEV1/FVC decreased >5% |
|
|
what is the step/management for intermittent asthma
|
step 1
SABA prn |
|
|
when do you increase from step 1 (just SABA prn)
|
if using the SABA > 2 days per week for control of symptoms (not prevention)
|
|
|
what is the step/management for mild persistent asthma
|
Step 2
Low dose ICS |
|
|
what is the step/management for moderate persistent asthma
|
Step 3
Low dose ICS + LABA |
|
|
what is the step/management for severe persistent asthma
|
Step4 or 5
Step 4: medium dose ICS + LABA Step 5: high dose ICS + LABA + consider omalizumab for allergies |
|
|
How should SABAs be given
|
dosed according to severity of symptoms
given up to 3 treatments at 20 minute intervals |
|
|
when can you step down?
|
good control x3 mo
|
|
|
What is the definition of well controlled
|
mimics intermittent asthma
|
|
|
how often to F/U with well controlled asthma
|
Q1-6mo
|
|
|
how often to F/U with not-well-controlled asthma
|
Q2-6wks
|
|
|
how often to F/U with poorly controlled asthma
|
2wks
|
|
|
How is "not well controlled" asthma defined
|
Symptoms >2 days/wk
Nighttime awakenings 1-3x/wk Some limitation SABA use >2days/wk FEV1 stays at 60-80% |
|
|
How to manage "not well controlled" asthma
|
Step up 1 step
Reeval in 2-6 wks |
|
|
How to manage poorly controlled asthma
|
consider short course oral corticosteroids
step up 1-2 steps reeval in 2 wks. |
|
|
What test is used for asthma dx
|
spirometry
|
|
|
how often is spirometry used for asthma
|
required for diagnosis
then every 1-2 years |
|
|
Define FEV1
|
the volume expired in the first second
|
|
|
what are the signs of asthma on spirometry
|
OBSTRUCTIVE pattern - ski slope
decreased rate at any volume longer forced expiration the plateau is delayed 10-12 seconds! |
|
|
What are the classes of short acting asthma meds and the meds in those classes used for asthma?
|
1. B-2 Adrenergic Receptor Agonist
- albuterol - levalbuterol - epinephrine 2. Anticholinergics - atropine - ipatromium bromide |
|
|
What are the classes & meds considered long acting/chronic mgt for asthma
|
(1) antiinflammatory
- Steroids - FLUTICASONE - Mast Cell Stabilizers - CROMLYN - IgE therapy - Leukotriene Modifiers - MONTELUKAST (2) Long acting B-2 Adrenergic recpt agonists - SALMETEROL - FORMOTEROL ** ALWAYS USE LABA WITH AN ANTI INFLAMMATORY |
|
|
Describe the medications (examples) that would be used as you increase management of asthma stepwise through the steps.
|
Step 1 - SABA - Albuterol PRN
Step 2 - Low ICS - Fluticasone (Flovent) Step 3 - either... (a) Med ICS - increase Fluticasone (b) Low ICS + LABA (ie ADVAIR: Fluticasone and Salmeterol) (c) Low ICS + Leukotriene Mod (ie Fluticasone and Singular) Step 4 - Med Dose ICS and LABA (increase the Advair dose) |
|
|
Describe the dosing of Fluticasone
|
Low Dose - 2 puffs of 44mcg each (88mcg) given BID
Med Dose - 2 puffs of 110mcg each (220mcg) given BID High Dose - 2 puffs of 220 mcg each (440mcg) given BID) |
|
|
Describe the dosing of Advair
|
Low: 100/50 Fluticasone/Salmeterol BID
Med: 250/50 Flut/Salmet BID High: 500/50 Flut/Salmet BID CHILD 4-11 - 100/50 DAILY |
|
|
What education is necessary for asthma
|
- avoidance of triggers
- patient and parent ed on how to use meds properly - recognizing s/s |
|
|
at what rate of usage of SABA should asthma management be increased to the next step (how often in a week)
|
SABA use 2x/wk --> go up a step.
|
