Pulmonary conditions & tobacco cessation: Asthma

Question 1

Classic symptoms of asthma

Answer 1

breathlessness
wheezing
chest tightness
coughing

Question 2

Common asthma triggers

Answer 2

Pollution
cigarettes
coldair/changes in weather
pets
dust/pollen
perfume
Drugs: aspirin, NSAIDs, beta-blockers

Question 3

FEV1

Answer 3

how much air can be forcefully exhaled in 1 second

Question 4

FVC

Answer 4

max volume of air exhaled after taking deep breath

Question 5

FEV1/FVC

Answer 5

percent of total air that can be forcefully exhaled in 1 second

Question 6

GINA Step 1

Answer 6

Daytime symptoms: < 2 X/month
Nighttime symptoms: none

Question 7

GINA Step 2

Answer 7

Daytime symptoms > 2X/month, < 4-5 days/week
Night: none

Question 8

GINA Step 3

Answer 8

Daytime symptoms: most days
Night: > 1/week

Question 9

GINA Step 4/5

Answer 9

Daytime symptoms:daily
Night > 1/week

Question 10

General asthma treatment approach

Answer 10

Start with which ever step based on symptoms
follow up 2-6 wks
counsel on appropriate technique
control risk factors
assess if need to step up therapy/down or maintain

once controlled can decrease visits 1-6 months

Question 11

SABA…

Answer 11

short acting beta 2 agonist

Question 12

ICS…

Answer 12

inhaled corticosteroid + relieved (formoterol preferred)

Question 13

LABA….

Answer 13

Long acting beta 2 agonist

Question 14

When are systemic steroids used in Asthma?

Answer 14

during exacerbations or severe asthma that is difficult to control

Question 15

MART is…

Answer 15

maintenance and reliever therapy

Question 16

Step 1 therapy

Answer 16

Rescue inhalers only:
As needed low-dose ICS-formoterol
or
SABA + low dose ICS

Question 17

Step 2 therapy

Answer 17

Rescue: As needed low-dose ICS-formoterol
or
Rescue: SABA & Maintenance: Low dose ICS

Question 18

Step 3 therapy

Answer 18

Rescue: Low dose ICS-formoterol & Maintenance same
or
Rescue: SABA + Maintenance: low dose ICS-LABA

Question 19

Step 4 therapy

Answer 19

Rescue: Low dose ICS-formoterol & Maintenance: Medium dose ICS-formoterol
or
Rescue: SABA & Maintenance: Medium dose ICS-LABA

Question 20

STEP 5 therapy

Answer 20

Rescue: Low dose ICS-formoterol & Maintenance: High dose ICS-formoterol
or
Rescue: SABA & Maintenance: High-dose ICS-LABA

Question 21

Asthma variability of control

Answer 21

well = keep current therapy
Partly = Step up 1 step
Uncontrolled = Step up 1-2 steps, maybe short course oral steroid

Question 22

SABA (albuterol) side effects

Answer 22

nervousness
tremor
tachycardia
palpitations
cough
hyperglycemia
decrease K

Question 23

LABA (salmeterol = serevent) Boxed warnings

Answer 23

inc risk of asth related deaths, only use if not well controlled on ICS
inc risk of asthma related hhospitalizations

Question 24

ICS warnings

Answer 24

high doses for long time can cause adrenal suppresion
inc risk of fractures, growth retardation and immunosuppression

Question 25

ICS Side effects

Answer 25

Difficulty speaking oral candidiasis = thrush cough

Question 26

ICS notes

Answer 26

rinse mouth with water and spit out after each use to prevent thrush, can use a spacer device to decrease risk

Question 27

Which ICS doesnt need to be shaken before use?

Answer 27

Alvesco (ciclesonide)

Question 28

Inhalers preferred for Asthma maintenance

Answer 28

ICS and ICS/LABA combo

Question 29

Inhalers preferred for COPD maintenance

Answer 29

LABA,LAMA or LAMA/LABA

Question 30

How to inhale a MDIs

Answer 30

slow, deep inhalation while pressing the canister

Question 31

How to inhale DPIs

Answer 31

quick, forceful inhalation

Question 32

Can you use spacer with DPI?

Answer 32

no

Question 33

Do you shake DPI?

Answer 33

no, unlike MDI

Question 34

Do you prime DPI?

Answer 34

no

Question 35

Montelukas (Singulair) boxed warnings

Answer 35

neuropsychiatric events

Question 36

LTRAs

Answer 36

Montelukas = LTD4 Zarfirlukast = LTD4 & LTE4 Zileuton = inhibit leukotriene formation

Question 37

Montelukast notes

Answer 37

montelukast granules = can admin directly to mouth, dissolve in milk/applesauce/carrots/rice or ice cream ONLY, use within 15min of opening packet

Question 38

Zafirlukast notes

Answer 38

dispense in original container

Question 39

Use of Theophylline is due to...

Answer 39

limited decrease of effectiveness, drug interactions and adverse effects

Question 40

Theophylline dosing

Answer 40

oral loading dose: 5mg/kg IBW maintenance is 300-600mg/day

Question 41

Theophylline levels

Answer 41

5-15 mcg/mil

Question 42

Theophylline side effects

Answer 42

N/V/HA/insomnia Toxicity = vomiting, arrhythmias, seizures

Question 43

Aminophylline to théophylline conversion =

Answer 43

multiple by 0.8

Question 44

Anticholinergics use in Asthma?

Answer 44

not used as stand alone therapy, usually add on treatments with ICS

Question 45

Omalizumab (Xolair) boxed warnings

Answer 45

anaphylaxis from 1st dose up to 1yr after

Question 46

Interleukin receptor antagonists are indicated for management of severe asthma with.....

Answer 46

eosinophilic phenotype

Question 47

IL-5 receptor antagonists.....

Answer 47

Mepolizumab reslizumab benralizumab

Question 48

IL-4 and IL-3 antagonists...

Answer 48

Dupilumab

Question 49

Dupilumab (Dupixent) info

Answer 49

> 12yrs or older, given SC every other week

Question 50

Benralizumab (Fasenra) info

Answer 50

> 12yrs or older, SC every 4 weeks for 3 doses, then Q 8 weeks

Question 51

Reslizumab (Cinqair) info

Answer 51

adults only, IV Q 4 weeks

Question 52

Mepolizumab (Nucala)

Answer 52

> 6yrs older, SC every 4 weeks

Question 53

Preventing exercise induced bronchospasm

Answer 53

SABA or low-dose ICS + formoterol 5-15 min before exercise preferred

Question 54

How long to wait inbetween inhalers if using more than 1?

Answer 54

60 seconds between each one bronchodilators should be used first

Question 55

Asthma action plan

Answer 55

Green = 80-100% personal best = all good continue maintenance Yellow = 50-80% personal best = worsening lung function, caution. Red = < 50% personal best = medical alert, go to ED