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PHAR253 > Asthma > Flashcards

Asthma Flashcards

1
Q

How is asthma characterized?

A

paroxysmal or persistent symptoms
dyspnea, chest tightnesss, wheezing, sputum & cough
airway hyper-responsiveness to a variety of stimuli
variable and occurs at any age
chronic inflammatory disorder

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2
Q

Provide a brief overview of the epidemiology of asthma.

A

> 3 million Canadians (Canada has one of the highest rates in the world)
childhood asthma is the #1 chronic condition in Canada
6/10 ppl do not have control

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3
Q

Describe the effects of asthma on mortality

A

250 ppl die/year in Canada (preventable)
most dont die from long-term progression
lifespan is unaltered
can maintain all activities of daily living
QOL can be same as non-asthmatic

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4
Q

What is the etiology of asthma?

A

genetic predisposition + environmental factors

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5
Q

Describe genetic predisposition for asthma.

A

multiple genes involved
-genes predisposing to atopy
-genes predisposing to airway hyper-responsiveness
-genes associated with response to treatment
sex
-childhood: male>female
-age 20: male=female
->age 40: female>male
obesity

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6
Q

What are the many environmental factors for ashtma?

A

tobacco smoke
allergen exposure (pollens, dander, dust mites)
infections in infancy (RSV, hygiene hypothesis)
environment (air, fog, smoke)
occupational sensitizers (chemicals)
exercise (mainly in cold, dry climate)
drugs/preservatives (NSAIDs, benzalkonium chloride, non-selective BB)
diet

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7
Q

Differentiate between asthma that is atopic and non-atopic.

A

atopic:
-allergy to antigens
-1/2 children and young adults
non-atopic:
-secondary to chronic/recurrent infections
-hypersensitivity to bacteria/viruses causing infection
can be mixed

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8
Q

Describe the impact of age on asthma.

A

can occur at any time but primarily a pediatric disease
-most diagnosed by 5, 50% of symptoms by 2
-most kids improve markedly or are symptom free by adulthood

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9
Q

What are the predictors of persistent adult asthma?

A

atopy
onset during school age
presence of bronchiole hyper-reactivity

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10
Q

What is the hallmark of asthma?

A

bronchial hyper-reactivity of airways to physical, chemical, and pharmacological stimuli

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11
Q

What can occur if anti-inflammatory therapy is not prescribed for asthma?

A

airway remodeling

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12
Q

Define the following:
bronchospasm
hyper-reactivity
airway remodeling

A

bronchospasm:
-constriction of the muscles in the walls of the bronchioles caused by inflammatory mediators
hyper-reactivity:
-an exaggerated response of the bronchial smooth muscle to triggers
-correlates with the course of the disease
airway remodeling:
-structural changes in the extracellular matrix in the airway wall leading to airflow obstruction
-may become only partially reversible

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13
Q

Differentiate the early asthmatic response from the late asthmatic response.

A

early:
-occurs in minutes
-causes bronchospasm
-mast cells–>histamine
late:
-occurs in hours (6-9hrs)
-bronchospasm returns, edema, hyper-responsiveness
-inflammatory cells

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14
Q

What is chronic asthma?

A

occurs in days
hyper-reactive airways, epithelial cell damage, mucous hypersecretion
leads to airway remodeling

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15
Q

What are the elements of diagnosis for asthma?

A
  1. medical history
    -symptoms and severity, history
    -precipitating factors
  2. physical exam
    -poor indicator of the degree of airflow obstruction
  3. pulmonary function tests
    -necessary for diagnosis
    -FEV1/FVC < 75-80% predicted
  4. other laboratory tests
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16
Q

What are three very important topics to ask about when collecting an asthma history?

A

amount of rescue med needed
symptoms at night
exercise induced

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17
Q

What are the main things we want to be asking about when collecting an asthmatics history?

A

symptoms and severity:
-severe episodes of symptoms?
-worsening during a season?
-worsening in certain locations or exposures?
-awakening at night?
-after exercise?
history:
-family history of asthma/allergies
-positive patient history of allergies
precipitating triggers
-variable between patients

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18
Q

What are some of the many triggers of asthma?

A

exercise
-drop in FEV1 of 15% or > from baseline (most asthmatics)
time of day
-nocturnal asthma (low cortisol and EP)
aero-allergens (smoke, fumes, pollen)
irritants (perfumes, air fresheners)
respiratory tract infections
-esp if <10yrs old or viral
weather (cold, dry or hot, humid)
psychological factors
hormonal fluctuations
GERD
medications
-ASA/NSAIDs, beta-blockers, benzalk chloride, contrast media

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19
Q

True or false: a physical exam is a good indicator of the degree of airway obstruction

A

false
poor indicator

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20
Q

What are some things that might be observed from a physical exam?

A

expiratory wheezing on auscultation
dry hacking cough
signs of atopy (allergic rhinitis and/or eczema)

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21
Q

What is the adult criteria for ashtma?

A

FEV1/FVC < 75-80% predicted
12% improvement in FEV1 post B2-agonist challenge or after course of controller therapy
spirometry preferred

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22
Q

What is a low FEV1 a predictor of?

A

exacerbation

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23
Q

How should we monitor progress of lung function?

A

at diagnosis and 3-6mo after initiating treatment
every 1-2 years for most adults

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24
Q

What is the diagnosis of asthma in kids?

A

FEV1/FVC <80-90% predicted
>12% increased in FEV1 post bronchodilator challenge or course of controller therapy
kids older than 6yrs
spirometry preferred

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25
Q

What are some laboratory tests that can be done for asthma?

A

eosinophil, CBC, IgE concentration
allergy skin tests
sputum eosinophils

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26
Q

Where do the asthma guidelines that we follow come from?

A

Canadian Thoracic Society

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27
Q

What is the definition of asthma control (chart)?

A

daytime symptoms: <2d/wk
nighttime symptoms: <1night/wk and mild
physical activity: normal
exacerbations: mild and infrequent
absence from school or work: none
need for reliever: <2 doses per week
FEV1 or PEF: >90% of PB
PEF diurnal variation: <10-15%
sputum eosinophils: <2-3%

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28
Q

Summarize good asthma control.

A

patient can:
-avoid symptoms during day and night
-need little or no reliever
-have productive, physically active lives
-normal or near-normal lung function
-avoid serious exacerbations

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29
Q

What are the goals of therapy for asthma?

A

prevent asthma-related mortality
maintain normal activity levels
prevent daytime and nocturnal symptoms
maintain normal (or near normal) spirometry
prevent exacerbations
provide optimal pharmacotherapy and avoid AE

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30
Q

What are the principles of asthma therapy?

A
  1. environmental control
  2. pharmacologic therapy
  3. appropriate use of inhalation therapy
  4. regular consultation with certified asthma educator
  5. graduated approach to therapy
  6. regular follow-up
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31
Q

Differentiate between endogenous stimuli and exogenous stimuli for asthma.

A

endogenous:
-stimuli generated inside the body
-GERD, stress, rhinitis
exogenous:
-stimuli generated outside the body
-irritants, allergens, exercise

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32
Q

How can an asthmatic with a pet try to perform environmental control?

A

remove the pet from home
HEPA filter
wash pets

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33
Q

Describe proper mold/fungus control to try help an asthmatic.

A

humidity in house <50%
clean moldy surfaces with a bleach cleanser
fix leaky faucets, pipes
refrain from walking in uncut fields, working with compost, & raking leaves

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34
Q

What kind of precautions can an asthmatic take if the outdoors are a trigger for them?

A

minimize outdoor activity when air quality is poor
keep windows closed; use an AC
consider increased anti-infl therapy prior to allergy season

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35
Q

How can house dust mites be minimized?

A

wash linen/blankets every week
vacuum weekly with a HEPA vacuum
humidity in house <50%
clean surfaces with damp cloth weekly
remove carpets, stuffed animals, etc
avoid bottom bunk

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36
Q

What is immunotherapy? What is its role in asthma?

A

administration of allergen in progressively higher doses to induce tolerance
limited role in adults
-must identify and use a single, well defined allergen
-inconvenient

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37
Q

Differentiate between a reliever and controller.

A

reliever:
-to have on hand and take only when needed (during an attack, dyspnea, or before exercising)
controller:
-prevents asthma attacks and inflammation
-take every day (even if no symptoms)
-acts slowly and works over the long-term

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38
Q

True or false: a controller will not help during an asthma attack

A

true

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39
Q

What is the MOA of SABAs?

A

selective B2 adrenergic agonist
-little effect on late (inflammatory) phase

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40
Q

What is the onset of SABAs?

A

5 minutes
-peak effect on FEV within 30 minutes

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41
Q

What is the indication of SABAs?

A

prevention of exercise induced or cold air induced bronchospasm
treatment of intermittent episodes of bronchospasm

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42
Q

True or false: equipotent doses of all adrenergic agents will produce the same degree of bronchodilation

A

true

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43
Q

What is the selectivity (a, B1, B2) and DOA of the following SABAs:
epinephrine
isoproterenol
metaproterenol
terbutaline
salbutamol

A

epinephrine:
-a=4, B1=4, B2=2
-DOA: 1-2hrs
isoproterenol:
-B1=4, B2=4
-DOA: 0.5-2hrs
metaproterenol:
-B1=3, B2=3
-3-4hrs
terbutaline:
-B1=1, B2=4
-DOA: 4-8hrs
salbutamol:
-B1=1, B2=4
-DOA: 4-8hrs

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44
Q

What are examples of SABAs?

A

salbutamol
terbutaline

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45
Q

What are the many adverse effects of SABAs?

A

tachycardia, palpitations
skeletal muscle tremor
nervousness, irritability, insomnia, headache
BP changes
cardiac arrythmias
increased blood glucose
hypokalemia at high doses
tachyphylaxis
children: excitement/hyperactivity

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46
Q

What are the drug interactions of SABAs?

A

beta-blockers: oppose effect of SABAs
loop/thiazide diuretics: increased risk of hypokalemia
TCAs: may increase AEs of SABAs
QT prolongation
less risk with inhaled therapy

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47
Q

What is the typical dosing of SABAs?

A

1-2 puffs q4-6hrs prn
-some patients use them 15min prior to exercise or triggers
-during an asthma attack, safe to take puffs every few mins

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48
Q

When should patients on SABAs be referred to their physician?

A

requiring their rescue med >2 times/week

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49
Q

How long do LABAs work? What are the adverse effects of LABAs?

A

slowly over a 12 hour period to keep airways open and muscles relaxed
-similar MOA to SABAs
AE are similar to SABAs

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50
Q

Are LABAs a controller or reliever?

A

controller
-formoterol also approved for rescue therapy

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51
Q

Are LABAs used alone?

A

never used alone in any age group
always added to inhaled steroid therapy

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52
Q

What are examples of LABAs?

A

formoterol (Oxeze)
-full agonist
salmeterol (Serevent)
-partial agonist
available in combination products only:
-vilanterol (+fluticasone=Breo)
-indacaterol (+mometasone=Atectura)

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53
Q

What is the selectivity (a, B1, B2) and DOA of the following LABAs:
salmeterol
formoterol
vilanterol
indacaterol

A

salmeterol
-B1=1, B2=4
-DOA= >12h
formoterol
-B1=1, B2=4
-DOA= >12h
vilanterol
-B1=1, B2=4
-DOA= >24h
indacaterol
-B1=1, B2=4
-DOA= >24h

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54
Q

What is the therapy that is most effective anti-inflammatory for the management of asthma?

A

inhaled corticosteroids
-most common and effective controller

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55
Q

Describe the use and onset of ICS.

A

require daily use
onset: days-weeks (maximal=months)

56
Q

What are the benefits of ICS?

A

improve lung function
decrease frequency/severity of attacks
increases QOL
decreases asthma mortality

57
Q

What is the MOA of ICS?

A

inhibit inflammatory response at all levels
inhibits the late asthmatic response & decreases bronchial hyper-responsiveness in asthma

58
Q

What are some examples of ICS?

A

fluticasone propionate/furoate
budesonide
ciclesonide
beclomethasone
mometasone

59
Q

Which ICS is preferred in pregnancy?

A

budesonide

60
Q

True or false: ICS have an effect on acute symptom relief

A

false

61
Q

Describe the dosing of beclomethasone for preschoolers (1-5yrs), children (6-11yrs), and adults/adolescents (>12yrs).

A

preschoolers
-low: 100
-medium: 200
children:
-low: <200
-medium: 201-400
-high: >400
adults:
-low: <200
-medium: 201-500
-high: >500 (max 800)

62
Q

Describe the dosing of budesonide for preschoolers (1-5yrs), children (6-11yrs), and adults/adolescents (>12yrs).

A

preschoolers
-na
children
-low: <400
-medium: 401-800
-high: >800
adults:
-low: <400
-medium: 401-800
-high: >800 (max 2400)

63
Q

Describe the dosing of ciclesonide for preschoolers (1-5yrs), children (6-11yrs), and adults/adolescents (>12yrs).

A

preschoolers
-low: <100
-medium: <200
children:
-low: <200
-medium: 201-400
-high: >400
adults:
-low: <200
-medium: 201-400
-high: >400 (max 800)

64
Q

Describe the dosing of fluticasone propionate for preschoolers (1-5yrs), children (6-11yrs), and adults/adolescents (>12yrs).

A

preschoolers:
-low: <200
-medium: 200-250
children:
-low: <200
-medium: 201-400
-high: >400
adults:
-low: <250
-medium: 251-400
-high: >500 (max 2000)

65
Q

Describe the dosing of mometasone for preschoolers (1-5yrs), children (6-11yrs), and adults/adolescents (>12yrs).

A

preschoolers:
-na
children:
-low: 100
-medium: 200-400
-high: >400
adults:
-low: 100-200
-medium: 200-400
-high: >400 (max 800)

66
Q

What are the side effects of ICS?

A

dysphoria, hoarseness, throat irritation, cough
thrush (rinse mouth)
URTI increase? (benefit>risk)
growth retardation in kids
-can occur in low-mod doses; does not seem to affect adult heigh
dose, drug, inhalation technique dependent

67
Q

What are some education points to provide about ICS?

A

regular use; delayed onset
spacer/rinse mouth & spit
wash face after each dose (if use spacer with mask)
efficacy reduced in patients who smoke

68
Q

What are drug interactions of ICS?

A

desmopressin: increased risk of hyponatremia

69
Q

What are contraindications of ICS?

A

initiation during untreated respiratory tract infection
precautions:
-HPA axis suppression upon dc
-long term steroid effects at high doses
-increase URTIs?

70
Q

What is the use of oral/IV corticosteroids in asthma?

A

short periods of time in acute, severe asthma

71
Q

What is the MOA of LTRAs?

A

antagonize effect of leukotrienes
-reduce airway inflammation, small variable bronchodilation

72
Q

What are the side effects of LTRAs?

A

headache
dizziness
heartburn
nausea
drowsiness
minimal & non-specific

73
Q

What is the only LTRA on the market?

A

Montelukast (Singulair)

74
Q

How efficacious are LTRAs?

A

variable patient response
NOT for reversal of acute bronchospasm
-must be taken regularly (hs dosing)

75
Q

True or false: you should not abruptly change someone from an ICS to an LTRA

A

true

76
Q

What are the age guidelines for LTRAs?

A

> 2 years

77
Q

What is the use of LTRAs?

A

alternative to increasing dose of ICS in patients who remain symptomatic
very mild asthmatics who cannot/will not use an ICS

78
Q

What are the advantages of LABA/ICS combo products?

A

as effective as separate medications
more convenient
enhanced adherence
ensures patient receives dose of ICS
avoids SABA dependence

79
Q

Which combo product can be used as a reliever?

A

Symbicort (formoterol + budesonide)
-up to 8 pfs/day

80
Q

True or false: methylxanthines are more effective bronchodilators than B-adrenergic agonists

A

false

81
Q

What is theophylline structurally related to?

A

caffeine

82
Q

What is the MOA of methylxanthines?

A

non-specific inhibition of phosphodiesterase, which causes mild bronchodilation
increases diaphragmatic contractility and enhances conciliary clearance

83
Q

What are the therapeutic uses of methylxanthines?

A

add on in patients that require high dose corticosteroid
used only in severe asthma cases
-no role in rescue therapy (delayed onset)
-safer, more effective agents has minimized use

84
Q

What are the side effects of methylxanthines?

A

diarrhea
nausea
heartburn
anorexia
headaches
nervousness
tachycardia
upset stomach

85
Q

What are the drug interactions of methylxanthines?

A

significant potential
-3A4 and 1A2 substrate

86
Q

Describe omalizumab as asthma treatment.

A

anti-IgE antibody
sc injection (150-375mg sc q2-4wks)
use (>6yrs): atopic asthma poorly controlled despite high-dose inhaled steroids and appropriate add-on therapy, w or w/o prednisone
AE: pain at injection site, rash, headache, fatigue
expensive

87
Q

When might tiotropium be considered for asthma?

A

add-on therapy for individuals >12yrs with severe asthma despite combination of ICS/LABA therapy

88
Q

Which antibiotics may decrease asthma exacerbations in >18yrs with severe asthma independent of their inflammatory profile?

A

macrolides

89
Q

What is the biggest change to the approach of asthma treatment in the past couple of years?

A

use of ICS with SABA early on
-alt: Symbicort PRN

90
Q

What is the role of IL-5 inhibitors (reslizumab, benralizumab, mepolizumab) and IL-4 and 13 inhibitors (duplimumab) in asthma?

A

severe eosinophilic asthma who experience recurrent asthma exacerbations despite high doses of ICS in addition to one other controller

91
Q

What is the biggest change made to the treatment approach in asthma during the past few years?

A

use of ICS with SABA early on
-alt: Symbicort PRN

92
Q

What is the rationale against SABA monotherapy?

A

even mild, intermittent asthma symptoms still have severe or fatal exacerbations
2/3 reduction in exacerbations when ICS added

93
Q

What are the two things we take into consideration when deciding on optimal treatment for asthma?

A

asthma control
risk of exacerbation

94
Q

What is the definition of “higher risk for exacerbation”?

A

one of the following:
1. history of prev severe exacerbation
2. poorly-controlled asthma as per CTS
3. overuse of SABA (>2 inhalers/year)
4. current smoker

95
Q

Differentiate between severe asthma exacerbation and mild exacerbation.

A

severe:
-any of: needs systemic steroids, ED visit, hospitalization
mild:
-increase in sx from baseline that does not require the above

96
Q

Describe the continuum of adjusting asthma therapy.

A

confirm diagnosis
environmental control, education and written action plan
SABA or Symbicort prn
ICS (LTRA as 2nd line)
1-11yrs: increase ICS, >12yrs: add LABA
6-11yrs: add LABA or LTRA, >12yrs: add LTRA and/or tiotropium

97
Q

Describe the treatment approach for patients on PRN SABA or no medication.

A

see slide 80

98
Q

What is the criteria for when to start an ICS if 12 and older?

A

if on prn SABA with well-controlled asthma at lower risk of exacerbation:
-continue prn SABA or switch to daily ICS+prn SABA or Symbicort prn
if on prn SABA with well-controlled asthma at higher risk of exacerbation:
-switch to either daily ICS+prn SABA or Symbicort prn

99
Q

What is the criteria for when to start an ICS if <12 years old.

A

if on prn SABA well-controlled asthma and lower risk for exacerbation:
-continue prn SABA or switch to daily ICS+prn SABA
if on prn SABA well-controlled asthma and higher risk for exacerbation:
-switch to daily ICS+prn SABA

100
Q

Differentiate the classifications of asthma severity.

A

very mild: prn SABA only
mild:
-low dose ICS (or LTRA) + prn SABA
-PRN Symbicort
moderate:
-low dose ICS + 2nd controller + prn SABA
-mod dose ICS +/- 2nd controller + prn SABA
-low-mod dose Symbicort + prn Symbicort
severe:
-high dose ICS + 2nd controller or systemic steroids

101
Q

Differentiate uncontrolled asthma vs severe asthma.

A

uncontrolled:
-previously asymptomatic pt intermittently develops symptoms
-can be addressed with self-management education and action plan
severe:
-remains poorly controlled despite best practices
-requires treatment with high-dose ICS and a 2nd controller for the previous year or systemic steroids for 50% of previous year

102
Q

How can we investigate uncontrolled asthma?

A

watch patient use their inhaler
assess adherence
remove risk factors and assess/manage comorbidities
confirm diagnosis of asthma
consider step-up therapy

103
Q

How often should asthma be reviewed?

A

1-3 months after treatment started, then q3-12 months
pregnancy: q4-6 weeks
after an exacerbation: within 1 week

104
Q

Differentiate between sustained step-up treatment, short-term step-up treatment, and day-to-day adjustment.

A

sustained step-up:
-at least 2-3 months if asthma poorly controlled
short-term step-up:
-for 1-2 weeks (ex: viral infection or allergen)
day-to-day adjustment:
-for pts prescribed low dose ICS/formoterol maintenance and reliever regimen

105
Q

In which patients should we consider stepping down asthma therapy?

A

stable patients without history of severe asthma, exacerbations, or risk factors for exacerbations:
-only consider if >3 months of control
-ensure patient is on board for a “therapeutic experiment”
-have a plan in place if step down fails
goal is to find lowest effective dose

106
Q

What are the general principles for stepping down controller treatment?

A

prepare for step-down:
-record level of symptom control and consider risk factors
-make sure the pt has a written action plan
-book a follow-up in 1-3 months
step down through available formulations
discontinuing ICS or LABA is not recommended in adults with asthma because of risk of exacerbations

107
Q

True or false: only select asthma patients should have a written action plan

A

false
all patients should work with a HCP to develop an action plan

108
Q

What should be included on an asthma action plan?

A

how to monitor and measure their symptoms
daily preventive management strategies
when and how to adjust meds
when to seek urgent care

109
Q

What is the use of the peak expiratory flow meter?

A

moderate-severe asthmatics or asthmatics who are poor perceivers or airway obstruction
used by patients at home to:
-monitor treatment course/response
-determine when emergency care is necessary
-identify allergens
-detect asymptomatic deterioration in lungs
allows patient to assume more responsibility & control in disease management

110
Q

What is the traffic light system of self-management?

A

green: good control, no changed required
yellow: worsening asthma, consult action plan
red: danger zone, seek emergency medical care

111
Q

What are the three components of asthma self-management?

A

self monitoring
written asthma action plan
regular medical review

112
Q

Describe the importance of adherence in asthma therapy.

A

poor adherence:
-contributes to uncontrolled sx, risk of exacerbations and asthma-related death
contributory factors:
-unintentional (forgetfulness, confusion)
-intentional (no perceived need, side effects, costs)

113
Q

What are the first signs of asthma exacerbation?

A

worsening pattern of symptoms
exercise intolerance
unusual fatigue
nocturnal awakening
PEF decline of ~20% from patients PB is likely exacerbation

114
Q

What are the risk factors for exacerbations?

A

poor adherence
suboptimal ICS use
high SABA use
obesity
chronic rhinosinusitis
GERD
pregnancy
allergen/pollution/smoking exposure
low FEV
exacerbation in last 12 months

115
Q

What is a severe asthma exacerbation?

A

prolonged, severe episode of asthma unresponsive to usual treatment
develops over hours to days

116
Q

Which medications should be avoided during a severe asthma exacerbation?

A

sedatives/hypnotics

117
Q

What are the goals of treatment for acute severe asthma?

A

correction of significant hypoxemia
rapid reversal of airway obstruction
reduction of the likelihood of relapse
development of a written asthma action plan in case of further exacerbation

118
Q

What is the treatment of acute severe asthma?

A

SABA+SAMA
-nebulized or MDI+spacer
corticosteroids
-oral or IV (IV if: too breathless, intubated, or unable to tolerate oral medication, severe asthma, unresponsive to treatment)
-improves symptoms within 2h, 6h maximal
-7 to 10 days course is common
oxygen:
-correct hypoxemia (O2S>90%)
magnesium IV (bronchodilator)
mechanical ventilation/intubation

119
Q

What is the home management criteria for an asthma exacerbation?

A

can follow their action plan
mild-moderate exacerbation (PEF>60% PB)
symptoms are bothersome but not debilitating
no comorbidities that place them at higher risk
should see MD if partial response to tx after 1-2 days

120
Q

When should a patient with an asthma exacerbation be admitted to the hospital?

A

PEF <60% of PB
breathless at rest, severe drowsiness, cannot speak full sentences
comorbidities
symptoms worsen despite increased SABA/controller use

121
Q

What is the magnitude of exercised-induced bronchospasm correlated with?

A

degree of BHR
body attempts to warm/humidify increased volume of air, results in release of mediators

122
Q

What is the treatment for exercise-induced bronchospasm?

A

scarf/mask
enhance level of physical fitness
optimize treatment to reduce BHR
prophylactic therapy (SABA 5mins prior)
LTRA
warm-up for about 10 minutes

123
Q

What are the phases of the development of ASA/NSAID induced asthma?

A
  1. chronic rhinitis
  2. chronic nasal congestion, anosemia, nasal polyps, mucosal thickening
  3. inflammation in lower airways
  4. acute sensitization to NSAIDs
124
Q

What are the symptoms of the acute phase of ASA/NSAID induced asthma?

A

nasal symptoms
worsening asthma symptoms
allergic symptoms (hives, angioedema)

125
Q

What is the management of ASA/NSAID induced asthma?

A

LTRAs first line
avoid NSAIDs
low doses of acetaminophen may be tolerated
aspirin desensitization (must regularly use aspirin after this)

126
Q

What is the risk of beta-blockers with asthma?

A

decreased response to B agonists
increased airway hyper-responsiveness
non-cardio selective poses the greatest risk (even ocular), cardio-selective present limited risk in low-mod doses

127
Q

What is occupational asthma? What are the symptoms?

A

asthma secondary to workplace exposures
symptoms:
-worse at work or after work hours
-go away when away from work/vacation
-may keep patient up at night
-may start after working with new substance
-co-workers have similar symptoms

128
Q

What are the complications of uncontrolled asthma during pregnancy?

A

premature birth
low birth weight
maternal blood pressure changes

129
Q

True or false: the benefits of medications for asthma during pregnancy outweigh the risks

A

true

130
Q

Describe the pregnancy safety profiles of asthma medications.

A

salbutamol, LABAs seem safe
ICS: all safe, budesonide most studied
LTRA: no known issues
theophylline: keep low end of TR
biologics: unknown

131
Q

Describe the breastfeeding safety profiles of asthma medications.

A

inhaled meds are ok
po corticosteroids are ok
theophylline: keep low end of TR
montelukast: transferred into breastmilk, but indicated for kids as young as 6 months

132
Q

What are the symptoms of asthma?

A

heterogenous disease
-intermittent episodes of wheezing, cough and dyspnea
-chest tightness and chronic cough in some

133
Q

Why are physical exams poor indicators of airway obstruction?

A

asthma is a disease of exacerbation and remission, so the patient may not have any signs or symptoms at the time of the exam

134
Q

What is the dosing of montelukast?

A

2-5yrs: 4mg hs
6-14yrs: 5mg hs
>15yrs: 10mg hs

135
Q

What are some situations that may have a possible role for montelukast?

A

suboptimal adherence to ICS
dose of inhaled steroid required to maintain control is very low (ex: EIB)
ASA/NSAID induced asthma

136
Q

What are the drug interactions of LABAs?

A

same as SABAs
beta blockers, diuretics, TCAs, QT

137
Q

Which ICS is dosed OD?

A

ciclesonide
the rest are dosed BID

PHAR253 (16 decks)

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