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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.