Asthma Thill

wasabi's version from 2015-10-14 18:58

Section 1

Question Answer
almost everyone with asthma hasallergies
how diagnose asthma children 5 and older?with spirometry. FEV1 pre and post bronchodilator. increase FEV1 more or equal to 12 change suggestive asthma
methacholine?hit acetylcholine receptor to stimulate bronchospasm. help diagnosis
how diagnose under 5 years old?symptoms and response to treatment
4 severities of asthmaintermittent, mild, mod, severe
goals of therapy reduce SABA use to less than or equal to 2 days week
particles need to be what size1 to 5 microns
usually need spacer/ maskunder 4 yoa
911 call when what symptoms?breathlessness, speechless, drowsy, use of accessory muscles
911 when PEFbelow 50%
need for quick relief med when PEF50 to 79 of personal best

Section 2

Question Answer
initial treatment at home=inhaled SABA. up to two treatments 20 mins apart or 2-6 puffs by MDI or nebulizer
good response to at home=no wheezing or dyspnea. PEF >or equal to 80% predicted or personal best.
what to do when good response-contact clinician. may continue inhaled SABA every 3 to 4 hours for 24-48 hours. consider short course of oral systemic steroids
incomplete response at home=persistent wheezing and dyspnea (tachypnea). PEF 50 to 79 %.
incomplete response what to do-add systemic steroid, continue SABA, contact clinician urgently (this day) what to do
poor response=marked wheezing and dyspnea. PEF below 50%
what to do poor response-add systemic. repeat inhaled SABA immed. distress is severe and nonresponsive to inital treatment call doc and go to ED. consider 911

Section 3

Question Answer
hospital mild to moderate=FEV1 or PEF over equal to 40%
hospital mild to mod what do?oxygen to acheive 02 sat, inhaled SABa by neb or MDI, up to 3 doses first hour. oral systemic steroid if no immed response of if patent recently took ssytemic steroid
hospital severe=FEV1 or PEF under 40%
hospital severe what do?0xygen, high dose inhaled SABA plus ipratropium by neb or MDI every 20 mins or cont 1 hour, oral systemic steroids
hospital impending or actual resp arrest=intubation and ventilation with 100% oxygen, nebulized SABA and ip, IV steroids, consider adjunct
when use cont SABA plus ipratropium?severe exacerbation below 40% and dont respond to initial treatment
when consider adjunctive agents?below 40%.....drowsiness...confusion....

Section 4

Question Answer
asthma for patients not on long term medication yet 0 to 11 yoanewly diagnosed or not adherent
symptoms for mild > 2 days per week but not daily
nightime awakenings mild 0-4 yoa1-2 x month
nightime awakenings mild 5-11 3-4 x month
SABA use for syptom control mild> 2 days/ week but not daily
interference with normal activity mildminor limitation
mild asthma start step 2
exacerbations mild2 in a year

Section 5

Question Answer
asthma for patients not on long term medication over 12 yoanewly diagnosed or not adherent
symptoms mildmore than 2 days per week but not daily
nightime awakenings mild3-4 times per month
SABA use for symtpoms mildmore than 2 days per week but not daily
interferent with normal activity mildminor limitation
exercerbations mild2 in a year

Section 6

Question Answer
Step 1 preferredSABA when needed
Step 2 preferredlow dose ICS for everyone
Step 2 alternativesingulair or theophylline. never recc cromolyn
step 3 preferredmedium dose ICS
step 3 alternativelow dose ICS + LABA, singulair, or theo
step 4 prefferedmed dose ICS + LABA. and consider adding xolair (omalizumab for over 12 yoa)
step 4 alternativemed dose ICS + singulair.
step 5 preferredhigh dose ICS + LABA. consider xolair adding
step 5 alternativehigh dose ICS + singulair
step 6 prefferedhigh dose ICS and LABA and oral steroid. consider xolair
step 6 alternativehigh dose ICS, singulair, steroid

Section 7

Question Answer
assessing control and adjusting
not well controlledsymptoms more than 2 days week but not throughout day
not well controlled nightime awakenings> or equal to 2 times per month but not more than or equal to 2 x per week
not well controlled interference with normal activitysome limitation
not well controlled SABA usemore than 2 days per week but not several times per day
exacerbations not well controlled2-3 per year
not well controlled treatment plan should bestep up 1 step. re evaluate in 2-6 weeks
very poorly controlled treatment plan should beconsider oral steroids, step up 1-2 steps and re evaluate 2 weeks. (step up multiple steps or treat as exacerbation)

Section 8

Question Answer
Spiriva update to guidelines saysworks in asthma. better than med dose ICS and noninferior to LABA
levalbuterol updateHR same. not better drug than albuterol. inhaler same cost but neb 5x cost
ICs add on therapy for childrenLABA better than ICS but dont use alone in asthma. must have LABA and steroid together.