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Flashcards in Asthma Deck (13):
1

What percentage of airway reversibility and change in FEV1 do you need in order to confirm the diagnosis of asthma?

> or = 12% and 200 ml in FEV1

2

PFT in asthmatic patient

FEV1 is decreased to <80% predicted
FVC may fall
TLC is normal to elevated
FRC is usually elevated

3

Mild intermittent asthma

symptoms <2x/week
nocturnal symptoms <2x/month
FEV1 or PEF >80% predicted

4

Mild persistent asthma

symptoms >2x/week but <1x/day
nocturnal symptoms >2x/month
FEV1 or PEF >80% predicted
PEF variability 20-30%

5

Moderate persistent asthma

daily symptoms, daily use of inhaled SABA
nocturnal symptoms >1x/week
FEV1 or PEF 60-80% predicted
PEF variability >30%

6

Severe persistent asthma

continual symptoms
frequent nocturnal symptoms
FEV1 or PEF <60% predicted
PEF variability >30%

7

What is asthma?

1) chronic airway inflammation
2) bronchial hyperresponsiveness
3) airflow limitation

8

Assessing asthma control and adjusting therapy in asthma

WELL-CONTROLLED: f/u q 1-6 months, consider step down (decrease ICS gradually 25-50% every 3 months) if well-controlled for at least 3 months.
NOT WELL-CONTROLLED: step up, reevaluate in 2-6 weeks
VERY POORLY CONTROLLED: consider short course oral steroids, step up 1-2 steps, reevaluate in 2 weeks

9

Stepwise asthma treatment approach in 0-4 y/o

Step 1: SABA prn
Step 2: low dose ICS (alternative: cromolyn or montelukast)
Step 3: medium dose ICS
Step 4: medium dose ICS + either LABA or montelukast
Step 5: high dose ICS + either LABA or montelukast
Step 6: high dose ICS + either LABA or montelukast
oral steroids

10

Stepwise asthma treatment approach in 5-11 y/o

Step 1: SABA prn
Step 2: low dose ICS (alternative: cromolyn, LTRA, nedocromil or theophylline)
Step 3: low dose ICS + either LABA, LTRA (leukotriene receptor antagonists), or theophylline) or medium dose ICS
Step 4: medium dose ICS + LABA (alternative: medium dose ICS + either LTRA or theophylline)
Step 5: high dose ICS + LABA (alternative: high dose ICS + either LTRA or theophylline)
Step 6: high dose ICS + LABA + oral steroids (alternative:
high dose ICS + either LTRA or theophylline + oral steroids

11

Stepwise asthma treatment approach in >= 12 y/o and adults

Step 1: SABA prn
Step 2: low dose ICS (alternative: cromolyn, LTRA (leukotriene receptor antagonists), nedocromil or theophylline)
Step 3: low dose ICS + LABA or medium dose ICS (alternative: low dose ICS + either LTRA, theophylline or zileuton)
Step 4: medium dose ICS + LABA (alternative: medium dose ICS + either LTRA, theophylline or zileuton)
Step 5: high dose ICS + LABA and consider omelizumab for patients who have allergies.
Step 5: high dose ICS + LABA + oral steroids and consider omelizumab for patients who have allergies.

12

Asthma Action Plan

Green Zone: >= PEF 80%
Yellow Zone: PEF 50-80%
Red Zone: <50% PEF

13

Stepwise asthma treatment in Pregnancy
Budenoside has the most reliable safety profile.

Mild intermittent: no daily medication
Mild persistent: low dose ICS
Moderate persistent: low dose ICS or medium dose ICS +/- LABA
Severe persistent: high dose ICS + LABA + if needed oral steroids