Asthma

Question 1

Asthma

Answer 1

a chronic disease of the airways that causes recurrent and distressing episodes

Question 2

Symptoms of asthma

Answer 2

wheezing, breathlessness, chest tightness, nighttime or early am coughing

Question 3

Asthma is triggered by

Answer 3

allergies, exercise, weather, certain foods, emotional states, outdoor pollution, smoke

Question 4

Difference between asthma and COPD

Answer 4

onset in mid-life, symptoms progress slowly, long smoking history, dyspnea during exercise, irreversible airflow in COPD, opposite in asthma+ allergy, rhinitis, family history

Question 5

Intermittent asthma

Answer 5

2x or less per week daytime symptoms, 2x or less per mo at noc

Question 6

Mild persistent

Answer 6

> 2x/week daytime, 2x or less per mo at noc

Question 7

Moderate persisstent

Answer 7

daily during day, 1x per week at noc

Question 8

severe persistent

Answer 8

continual during day, frequent at noc

Question 9

All pts classified in persistent asthma category will require what

Answer 9

controller medication

Question 10

intermittent asthma treatment

Answer 10

short acting B2 agonist

Question 11

persistent mild asthma treatment

Answer 11

low dose corticosteroids, short acting B2 agonist

Question 12

persistent moderate asthma treatment

Answer 12

corticosteroids, LABA, SABA, alternatives or leukotriene modifiers, mast cell stabilizers

Question 13

persistent severe asthma treatment

Answer 13

coricosteroids, LABA, SABA, alternatives leukotriene modifiers, mast cell stabilizers, oral corticosteroids, theophylline; poorly controlled regardless of age

Question 14

Severity vs control

Answer 14

severity- the intrinsic intensity of the disease process, control- the degree to which the goals of therapy are met; severity is generally not discussed after diagnosis

Question 15

persistent asthma step 6

Answer 15

high dose ICS+LABA and oral corticosteroid

Question 16

Persistent asthma step 5

Answer 16

high dose ICS+LABA

Question 17

Persistent asthma step 4

Answer 17

medium dose ICS+LABA

Question 18

Persistent asthma step 3

Answer 18

low dose ICS+LABA or medium dose ICS

Question 19

Persistent asthma Step 2

Answer 19

low dose ICS

Question 20

Intermittent asthma step 1

Answer 20

SABA as needed

Question 21

The basic approach

Answer 21

for persistent asthma start with a low dose ICS. Add LABA if not well controlled. Once a LABA is added titrate up ICS to maximal dose if still not controlled

Question 22

if well controlled what do you do

Answer 22

after 3 months consider down stepping

Question 23

Alternative agents

Answer 23

Monteludast (Singulair), Zafirlukast ( Accolate), Zileuton (Zyflo); for persistent, moderate asthma

Question 24

Alternative agents MOA

Answer 24

leukotriene inhibitors, only available PO

Question 25

Alternative agents ADRs

Answer 25

well tolerated, agitation (anxiety, hallucinations, unusual dreams)

Question 26

Cromolyn (Intal)

Answer 26

alternative agents, mast cell stabilizer, only inhaler only, for persistent moderate asthma, very limited

Question 27

Omalizumab (Xolair)

Answer 27

anti-IgE therapy, if failed everything else do this, moderate to severe asthma; ADRs anaphylaxis, HA, thrombocytopenia

Question 28

Severe asthma, why do pts get hospitalized

Answer 28

non-adherence, continue exposure to triggers, incomplete assessment of co-morbidities, inadequate follow-up, pt response to meds

Question 29

Risk factors of mortality

Answer 29

severe exacerbation, 2+ hospitalizations, 3+ ED visists in last year, >2 canisters/mon, diff perceiving symptoms, low socioeconomic, psych probs, comobidities