3: Adult Asthma

Question 1

Should you treat asthma during pregnancy?

Answer 1

Yes, beneficial outcomes for both mother and child. Asthma worsens for 1/3 and gets better for 1/3.

Question 2

Should the PCP or OBGYN manage asthma during pregnancy?

Answer 2

PCP has better access to tools for treatment.

Question 3

Most asthma medications are what pregnancy classification?

Answer 3

C

Question 4

How do you manage an acute exacerbation?

Answer 4

• Rapidly establish severity.
  
  • Concomitantly measure oxygen saturation; watch patient breathe; see if able to talk while breathing.
• Check for and correct hypoxemia while figuring out modality to open up lungs.
• Administer quick-relief medications.
• Administer oral steroids while waiting for the EMTs.
• Transferred to the hospital?
  
  • Yes: Continue to monitor the patient upon discharge.
  • No: Follow up within 2–7 days before treatment has been completed to assess success of treatment.

Question 5

What exacerbations require steroids?

Answer 5

Moderate to severe.

Question 6

Mild, moderate, severe, or life-threatening exacerbation?

• Dyspnea interferes with or limits usual activity
• Peak flow is 40–69% of predicted
• Relief from frequently inhaled SABA
• Treatment: oral corticosteroids
• Relief within 1-2 days

Answer 6

Moderate

Question 7

When do you transfer a patient to the ER?

Answer 7

• Worsening respiratory distress
• Persistent distress
• Persistent hypoxemia

Question 8

Mild, moderate, severe, or life-threatening exacerbation?

• Dyspnea with activity Pulmonary function is 70% of predicted
• Prompt relief with short-acting beta agonist (SABA)

Answer 8

Mild

Question 9

What is the steroid dosing for adults outpatient?

Answer 9

• Prednisone/Prednisolone
• 1-2 mg/kg/day
• Max 40-80 mg/day

Question 10

Mild, moderate, severe, or life-threatening exacerbation?

• Patient is unable to speak and perspiring.
• Peak flow is less than 25% of predicted.
• Patient is on continuous nebulizers and no relief from SABAs.
• Hospitalization is required, potentially in ICU.
• Treatment: Intravenous corticosteroids are a mainstay, while adjunctive therapies depend on what is popular.

Answer 10

Life-threatening

Question 11

When is treatment failure considered in outpatient care?

Answer 11

If there are 3 back-to-back albuterol nebs or duo nebs without complete relief.

Question 12

Mild, moderate, severe, or life-threatening exacerbation?

• Dyspnea at rest and difficulty with regular conversation
• Peak flow less than 40% of predicted or personal best
• Partial relief from frequently inhaled SABAs
• Never receive complete relief
• Treatment: oral corticosteroids or IV corticosteroids in the hospital
• Relief: symptoms persist for 3 days past the prescription

Answer 12

Severe (ER or hospitalize)

Question 13

What is the preferred ICS in pregnancy?

Answer 13

Budesonide

Question 14

What is the preferred SABA in pregnancy?

Answer 14

Albuterol

Question 15

What is the preferred antihistamine in pregnancy if needed to control asthma and allergies or atopy together?

Answer 15

Loratidine or cetirizine (2nd gen)