Asthma

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Author:
wcameron
ID:
220314
Filename:
Asthma
Updated:
2013-05-30 18:55:29
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Asthma
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Description:
Asthma
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  1. What is asthma?
    Chronic inflammation of the small airways

    Symptoms of recurrent episodes of airflow obstruction or airway hyper-responsiveness

    Defined as having REVERSIBLE airway obstruction

    NHLBI EPR-3 Guidelines
  2. Asthma symptom clues
    Do the patient's cold 'go to the chest' or take > 10 days to resolve?

    Does the pt. take any medication? Is there relief when symptoms occur? (bronchodilator)
  3. Risk Factors for asthma
    Causal factors: Indoor allergens (domestic animals, cockroach allergens, fungi/molds) Outdoor allergens (pollens, fungi, RSV) Occupational exposure

    Host Factors: genetic atopy (increased IgE, AWHR)

    Contributing factors: resp. infections, small size at birth, obesity, diet, air pollution, smoking (active/passive)
  4. Diagnosing Asthma
    Spirometry is recommended for diagnosis.  FVC, FEV1, before and after bronchodilator

    PEF (peak expiratory flow) changes from morning to night are an objective indicator.

    Dx: episodic symptoms of airflow obstruction must be present, must be at least partially reversible, and other diag. ruled out.
  5. What is the most common presenting symptom in asthma?
    persistent cough, especially at night
  6. Changes in an acute exacerbation
    increased residual volume, peak expiratory flow decreases. Leads to respiratory alkalosis & hypocapnea.
  7. What is an easy SCREENING test for asthma?
    Peak Expiratory Flow (PEF)
  8. What is a diagnostic test for asthma?
    Spirometry including post-bronchodilator response to prove > or = 15% reversibility
  9. Parameters for MILD INTERMITTENT ASTHMA
    PEFR or FEV1 > 80%

    PFT variability > 20%
  10. Parameters for MILD PERSISTENT ASTHMA
    PEFR or FEV1 > 80%

    PFT variability 20-30%
  11. Parameters for MOD. PERSISTENT ASTHMA
    PEFR or FEV1 60-80%

    PFT variability > 30%
  12. Parameters for SEVERE PERSISTENT ASTHMA
    PEFR or FEV1 < or = 60%

    PFT variability > 30%
  13. Step 1 treatment for Mild intermittent asthma
    SABA PRN up to 4xdaily

    (no long-term med needed)
  14. Step 2 treatment for Mild Persistent Asthma
    ICS (low-dose) for maintenance

    SABA PRN
  15. Step 3 treatment for Moderate persistent asthma
    ICS + LABA combo

                or

    Medium dose ICS

    (may add leukotriene modifier, theophylline)
  16. Step 4 Severe persistent asthma treatment
    SABA PRN

    Medium/high dose ICS + LABA

    leukotriene modifier or theophylline
  17. Step 5 treatment
    low dose oral corticosteroid

    XOLAIR (anti-IgE)

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