General asthma Flashcards
what medications can trigger asthma?
beta-blockers, ACE-I, ASA, NSAIDs, COX-2
what cells are involved in early asthma response?
T-helper cells: active B cells
B cells: produce IgE to bind to mast cells
Mast cells: degranulate to release inflammatory markers
Eosinophils: release toxic neuropeptides –> increase hyperresponsiveness
4 questions to assess symptom control for asthma:
in the last four weeks,
- day time symptoms > 2x/week?
- any night time wakening due to asthma?
- SABA use > 2 x/week
- any activity limitation due to asthma?
timing of symptoms
when are they worse (usually)?
at night and early morning
with URTI, after exercise with exposure to allergens
4 characteristic symptoms of asthma?
-recurrent symptoms of:
- wheezing
- dyspnea
- cough (esp at night)
- exercise intolerance
what is the preferred diagnostic test for asthma in children age 6 and older?
spirometry for kids 6 and older
FEV1 > 12% after bronchodilator –> evidence of reversibility
*use age-adjusted spirometry for older adults
overuse of SABA, defined as > _____ canisters/year is associated with increased risk of _______
> 3 canisters/year
increased risk of exacerbations
> 12 canisters/year
increased risk of death
Canadian Thoracic Society: risk factors for asthma exacerbation?
- any hx of previous severe asthma exacerbation (systemic steroids, ER, hospitalization)
- poorly controlled asthma
- overuse of SABA (>2 inhalers of SABA in a year) *check Pharmanet
- current smoker
GINA recommends this interval for follow up monitoring:
- in pregnancy?
- after exacerbation?
in pregnancy: q4-6 weeks
after exacerbation: within 1 week
starting asthma medication in adults and kids 12+ with diagnosis of asthma:
- if symptoms twice/month or more:
- if symptoms most days or waking at night at least once/week:
- if daily symptoms, waking up at night once/week or more AND low lung function:
-if symptoms twice a month or more:
PRN low-dose ICS-formoterol
-if symptoms most days OR waking up at night at least once/week:
low-dose ICS-formoterol maintenance and reliever
-if symptoms daily OR waking at night once/week or more AND low lung function:
medium dose ICS-formoterol maintennace and reliever
assessment of these 5 areas before starting asthma treatment:
- CONFIRM diagnosis
- SYMPTOM control and modifiable risk factors
- COMORBIDITIES
- INHALER technique and adherence
- PATIENT preference and goals
adults and kids older than 12
Treatment for
step 1: intermittent symptoms
-symptoms 2x or less/week
PRN low dose ICS-LABA
OR
take low dose ICS whenever SABA is taken
adults and kids older than 12
Treatment for
Step 2: mild persistent symptoms
-symptoms > 2x/week but not daily, 2 or more times/month, nighttime 3-4x/month
PRN low-dose ICS-LABA
OR
Low dose ICS and PRN SABA
adults and kids older than 12
Treatment for
Step 3: moderate persistent symptoms
-symptoms most days, waking up at night 1x/week but not daily
Low dose ICS-LABA regularly and as reliever
OR
Low dose ICS-LABA and PRN SABA
adults and kids older than 12
Treatment for
step 4: moderate to severe persistent asthma
-symptoms daily, frequent night symptoms (once/week or more, poor lung function)
medium dose ICS-LABA regularly and as reliever
OR
Med/high dose ICS-LABA and PRN SABA
REFER for expert advice
