Questions and Answers
Which medication is categorized as a leukotriene receptor antagonist?
Omalizumab requires administration every 1-2 weeks.
False
What is the normal peak expiratory flow rate (PEFR) percentage for a healthy individual based on predicted values?
greater than 70%
For a patient experiencing severe asthma, a peak expiratory flow below ___ indicates a severe exacerbation.
Signup and view all the answers
Match the following asthma medications to their intended use:
Signup and view all the answers
What action should be taken if a patient does not improve after SABA and has a peak flow between 50% to 70%?
Signup and view all the answers
In a situation of hyperventilation, the partial pressure of CO2 is expected to be high.
Signup and view all the answers
What is a key indicator of a life-threatening asthma exacerbation?
Signup and view all the answers
While using asthma medications, it is contraindicated to use certain treatments without concurrent _____.
Signup and view all the answers
Which is an associated risk of using certain asthma medications?
Signup and view all the answers
What defines Severe Persistent Asthma?
Signup and view all the answers
Mild Persistent Asthma is classified by having more than two daytime symptoms per week but less than daily.
Signup and view all the answers
What medication is typically used for treatment of Intermittent Asthma?
Signup and view all the answers
Inhaled corticosteroids help to reduce inflammation by inhibiting ______ release.
Signup and view all the answers
Which of the following is a common adverse effect associated with SABA?
Signup and view all the answers
Match the type of asthma with its characteristic:
Signup and view all the answers
What is the FEV1 measurement range for Moderate Persistent Asthma?
Signup and view all the answers
LABA can be used alone for acute episodes in asthma treatment.
Signup and view all the answers
Adverse effects of inhaled corticosteroids may lead to the development of ______.
Signup and view all the answers
Which medication is commonly used for nighttime symptoms in asthma treatment?
Signup and view all the answers
What is the primary treatment for Mild Persistent Asthma?
Signup and view all the answers
Inhaled corticosteroids primarily provide bronchodilation.
Signup and view all the answers
What FEV1 percentage indicates Severe Persistent Asthma?
Signup and view all the answers
The main adverse effect associated with SABA use is __________.
Signup and view all the answers
Match each type of asthma with its description:
Signup and view all the answers
What is an additional treatment option for Severe Persistent Asthma if the initial treatment is not responsive?
Signup and view all the answers
Long-acting beta-2 agonists (LABA) can be used alone for acute asthma episodes.
Signup and view all the answers
List one common adverse effect of inhaled corticosteroids.
Signup and view all the answers
Mild Persistent Asthma is characterized by nighttime symptoms occurring __________ times per month.
Signup and view all the answers
Which medication is typically used as needed for intermittent asthma symptoms?
Signup and view all the answers
What is a potential side effect associated with leukotriene receptor antagonists?
Signup and view all the answers
Cromolyn sodium is useful for exercise-induced asthma.
Signup and view all the answers
What is the expected peak flow percentage for a normal individual?
Signup and view all the answers
In the case of hyperventilation, the pCO2 level is expected to be _____ due to excessive exhalation.
Signup and view all the answers
Match the following asthma medications with their characteristics:
Signup and view all the answers
Which of the following is a suitable treatment option during a life-threatening asthma exacerbation?
Signup and view all the answers
Continuous monitoring and supportive care are unnecessary for a patient with an acute asthma exacerbation.
Signup and view all the answers
What is one indicator of severe asthma exacerbation based on peak flow percentage?
Signup and view all the answers
If the patient's peak flow is between 50% to 70% after SABA, further assessment including an _______ analysis should be considered.
Signup and view all the answers
What is the required frequency for administering Omalizumab?
Signup and view all the answers
What FEV1 percentage indicates Intermittent Asthma?
Signup and view all the answers
Inhaled corticosteroids can lead to oral candidiasis if proper mouth rinsing is not performed.
Signup and view all the answers
What is the primary treatment for Moderate Persistent Asthma?
Signup and view all the answers
For Mild Persistent Asthma, nighttime symptoms occur __________ times per month.
Signup and view all the answers
Match the asthma types with their FEV1 measurements:
Signup and view all the answers
What adverse effect is commonly associated with the use of SABA medications?
Signup and view all the answers
LABA should be used alone for acute asthma episodes.
Signup and view all the answers
List one common medication used as a short-acting beta-2 agonist (SABA).
Signup and view all the answers
For Severe Persistent Asthma, symptoms occur __________ throughout the day.
Signup and view all the answers
Which medication is primarily used to manage inflammation in asthma?
Signup and view all the answers
Which medication is known to inhibit bronchoconstriction and mucus production?
Signup and view all the answers
Cromolyn sodium is primarily used to treat exercise-induced asthma.
Signup and view all the answers
What is the role of SABA in asthma management?
Signup and view all the answers
In cases of severe asthma exacerbations, patients may require ______ medications for management.
Signup and view all the answers
Match the following asthma medications with their corresponding characteristics:
Signup and view all the answers
What is a potential adverse effect related to leukotriene receptor antagonists?
Signup and view all the answers
Continuous monitoring is necessary for stabilizing a patient during an acute asthma exacerbation.
Signup and view all the answers
What percentage of predicted peak flow indicates a severe asthma exacerbation?
Signup and view all the answers
In hyperventilation, the partial pressure of CO2 (pCO2) is expected to be _____ due to excessive exhalation.
Signup and view all the answers
When should high-dose corticosteroids or intravenous medications be considered?
Signup and view all the answers
What is the primary treatment for Moderate Persistent Asthma?
Signup and view all the answers
Severe Persistent Asthma is characterized by FEV1 measurements less than 60%.
Signup and view all the answers
How often do nighttime symptoms occur for Mild Persistent Asthma?
Signup and view all the answers
SABA medications primarily provide __________ by activating beta-2 adrenergic receptors.
Signup and view all the answers
Match the type of asthma with its FEV1 measurement range:
Signup and view all the answers
Which medication is commonly used for treating nighttime symptoms in asthma?
Signup and view all the answers
Inhaled corticosteroids help to reduce inflammation primarily by activating cytokine release.
Signup and view all the answers
What adverse effect is commonly associated with inhaled corticosteroids?
Signup and view all the answers
For individuals with Asthma, a peak expiratory flow below __% indicates a severe exacerbation.
Signup and view all the answers
What treatment is typically added for Severe Persistent Asthma if the initial treatments are not responsive?
Signup and view all the answers
Which medication is indicated for exercise or cold-induced asthma?
Signup and view all the answers
Leukotriene receptor antagonists are primarily used to increase bronchoconstriction.
Signup and view all the answers
What is a significant associated risk of using certain asthma medications?
Signup and view all the answers
For a life-threatening asthma exacerbation, the rapid assessment of response to __________ is crucial.
Signup and view all the answers
Match the following asthma treatments to their characteristics:
Signup and view all the answers
What percentage of predicted peak flow indicates severe asthma if it is below this value?
Signup and view all the answers
Continuous monitoring and supportive care are necessary for stabilization in acute asthma exacerbations.
Signup and view all the answers
What should be done if a patient with a peak flow between 50% to 70% does not improve after SABA?
Signup and view all the answers
For a peak expiratory flow rate (PEFR), normal peak flow should be greater than _________ of the predicted value.
Signup and view all the answers
Which adverse effect is associated with leukotriene receptor antagonists?
Signup and view all the answers
What characterizes a severe asthma exacerbation based on peak flow measurement?
Signup and view all the answers
Leukotriene receptor antagonists have no association with mood changes.
Signup and view all the answers
Which medication is used for exercise-induced asthma management?
Signup and view all the answers
A normal peak expiratory flow rate (PEFR) should be greater than ______ of the predicted value.
Signup and view all the answers
Match the following medications with their associated risks:
Signup and view all the answers
When should high-dose oral corticosteroids be considered in asthma exacerbation management?
Signup and view all the answers
Continuous monitoring and supportive care are optional for a patient with an acute asthma exacerbation.
Signup and view all the answers
What is a potential side effect of using SABA medications?
Signup and view all the answers
In hyperventilation, low pCO2 is expected due to excessive ______ exhalation.
Signup and view all the answers
What is the required administration frequency for Omalizumab?
Signup and view all the answers
What is the treatment for Mild Persistent Asthma?
Signup and view all the answers
Severe Persistent Asthma is characterized by symptoms that occur only once a week.
Signup and view all the answers
What does FEV1 stand for?
Signup and view all the answers
The primary bronchodilator used as needed for asthma symptoms is known as a __________.
Signup and view all the answers
Match each type of asthma with its corresponding FEV1 measurement:
Signup and view all the answers
Which of the following is a common adverse effect of inhaled corticosteroids?
Signup and view all the answers
LABA should be used alone for managing acute asthma episodes.
Signup and view all the answers
What is the expected FEV1 percentage for Intermittent Asthma?
Signup and view all the answers
In Moderate Persistent Asthma, nighttime symptoms occur at least __________ per week.
Signup and view all the answers
Which medication is typically used for long-term control in combination with ICS?
Signup and view all the answers
Study Notes
Asthma Classification and Treatment
-
Asthma is classified according to the frequency of daytime and nighttime symptoms, and FEV1 measurement.
-
Intermittent Asthma:
- Less than two daytime symptoms per week.
- Less than three nighttime symptoms per month.
- FEV1 greater than 80%.
- Treatment: Short-acting beta-2 agonist (SABA), typically used as needed (PRN).
-
Mild Persistent Asthma:
- More than two daytime symptoms per week but less than daily.
- Nighttime symptoms occur three to four times per month.
- FEV1 ≥ 80%.
- Treatment: SABA PRN plus low-dose inhaled corticosteroids (ICS), such as fluticasone or budesonide.
-
Moderate Persistent Asthma:
- Daily daytime symptoms.
- Nighttime symptoms occurring at least once per week.
- FEV1 between 60-80%.
- Treatment: SABA PRN plus medium-dose ICS, or low-dose ICS with long-acting beta-2 agonists (LABA).
-
Severe Persistent Asthma:
- Symptoms occur daily throughout the day.
- Nighttime symptoms occur nightly.
- FEV1 < 60%.
- Treatment options:
- SABA PRN, medium-dose ICS, and LABA.
- If not responsive, increase to high-dose ICS + LABA.
- Oral corticosteroids may be added for severe cases.
Medication Mechanism of Action
-
SABA (e.g., Albuterol):
- Provides bronchodilation by activating beta-2 adrenergic receptors in bronchial smooth muscles.
- Common administration forms: metered-dose inhaler (MDI), dry powder inhaler (DPI), nebulizer.
- Adverse effects: tachyarrhythmias, tremors, dizziness, contraindicated in patients with heart issues or narrow-angle glaucoma.
-
Inhaled Corticosteroids:
- Reduce inflammation by inhibiting cytokine release and the chemotaxis of white blood cells.
- Common drugs: fluticasone, budesonide, mometasone.
- Adverse effects: possibility of oral candidiasis (thrush), hence mouth rinsing is advised.
-
LABA (e.g., Salmeterol, Formoterol):
- Long-acting agents used in combination with ICS.
- Should never be used alone for acute episodes due to risk of worsening symptoms.
- Associated risks: tachyarrhythmias, trembling, contraindicated without concurrent ICS.
Alternative Treatment Options
-
Mast Cell Stabilizers:
- Example: Cromolyn sodium, useful for exercise or cold-induced asthma, inhibits histamine release.
-
Leukotriene Receptor Antagonists:
- Example: Montelukast (Singulair), inhibits bronchoconstriction and mucus production.
- Associated with potential mood changes and suicidal ideation.
-
Omalizumab:
- Anti-IgE antibody treatment, useful in severe allergic asthma; very costly and requires administration every 2-4 weeks.
Management of Acute Exacerbation
- For life-threatening or near-fatal exacerbations, immediate intervention is crucial:
- Administer SABA and ensure rapid assessment of response.
- Consider high-dose oral corticosteroids or intravenous medications if no improvement.
- Continuous monitoring and supportive care are necessary to stabilize the patient.### Asthma Exacerbation Management
- Peak Expiratory Flow Rate (PEFR) is utilized in acute asthma management when Pulmonary Function Tests (PFTs) are impractical.
- Normal peak flow should be greater than 70% of the predicted value based on age, gender, and height.
Patient Assessment
-
Situation 1: Patient improves after taking a Short-Acting Beta Agonist (SABA); peak flow is likely above 70%. Discharge may be appropriate.
-
Situation 2: If the patient has a peak flow between 50% to 70% and has not improved after SABA, consider further assessment, including an Arterial Blood Gas (ABG) analysis.
-
ABG Results:
- pH, partial pressure of CO2 (pCO2), partial pressure of O2 (pO2), and bicarbonate levels are measured.
- In hyperventilation, expect low pCO2 due to excessive CO2 exhalation.
Severe Exacerbation Indicators
-
Situation 3: Elevated respiratory and heart rate (20-25 breaths/min and >100 bpm); peak flow between 25% to 50% indicates severe asthma. Abnormal ABG expected, usually showing low pCO2.
-
Situation 4: Peak expiratory flow below 25% and O2 saturation (<92%) signals potential respiratory failure. Lack of wheezing indicates severe obstruction; normal pCO2 suggests respiratory fatigue.
-
Situation 5: Elevated pCO2 in conjunction with peak flow <25% indicates severe obstruction and impending respiratory acidosis. Immediate intervention required.
Treatment Protocol
- Administer non-rebreather mask with supplemental oxygen targeting O2 saturation >92%.
- Provide Short-Acting Beta Agonist (e.g., albuterol) combined with Ipratropium Bromide, which prevents bronchoconstriction by blocking acetylcholine.
- If ineffective, initiate corticosteroids (IV or oral) for inflammation.
- Explore IV Magnesium Sulfate for severe cases; it enhances smooth muscle dilation by blocking calcium channels.
- If other measures fail, consider positive pressure ventilation or intubation for airway protection.
Discharge Protocol
- Upon stabilization, discharge typically includes an oral corticosteroid taper using a Medrol Dose Pack for ongoing symptom management.
Asthma Classification and Treatment
-
Asthma is categorized based on the frequency of symptoms and FEV1 levels.
-
Intermittent Asthma:
- Daytime symptoms <2 times/week; nocturnal symptoms <3 times/month.
- FEV1 ≥ 80%.
- Treatment: Short-acting beta-2 agonist (SABA) as needed.
-
Mild Persistent Asthma:
- Daytime symptoms >2 times/week but <1 time/day; nighttime symptoms 3-4 times/month.
- FEV1 ≥ 80%.
- Treatment: SABA as needed + low-dose inhaled corticosteroids (ICS).
-
Moderate Persistent Asthma:
- Daily daytime symptoms; nighttime symptoms at least once/week.
- FEV1 between 60-80%.
- Treatment: SABA as needed + medium-dose ICS, or low-dose ICS + long-acting beta-2 agonists (LABA).
-
Severe Persistent Asthma:
- Daily symptoms; nighttime symptoms nightly.
- FEV1 < 60%.
- Treatment: SABA as needed + medium-dose ICS + LABA, or escalate to high-dose ICS + LABA. Oral corticosteroids may be necessary for severe cases.
Medication Mechanism of Action
-
SABA (e.g., Albuterol):
- Bronchodilation via beta-2 adrenergic receptor activation.
- Available as metered-dose inhaler, dry powder inhaler, or nebulizer.
- Side effects include tachyarrhythmias and tremors; contraindicated in patients with heart issues.
-
Inhaled Corticosteroids:
- Reduce inflammation by inhibiting cytokines and chemotaxis of white blood cells.
- Examples include fluticasone and budesonide.
- Risks include oral thrush; mouth rinsing is recommended after use.
-
LABA (e.g., Salmeterol, Formoterol):
- Long-acting; used with ICS, not alone for acute episodes.
- Associated with risks like tachyarrhythmias; use must be combined with ICS.
Alternative Treatment Options
-
Mast Cell Stabilizers:
- Example: Cromolyn sodium; prevents histamine release, effective for exercise or cold-induced asthma.
-
Leukotriene Receptor Antagonists:
- Example: Montelukast (Singulair); reduces bronchoconstriction and mucus production.
- Risks include potential mood changes and suicidal ideation.
-
Omalizumab:
- Anti-IgE treatment for severe allergic asthma; expensive and requires administration every 2-4 weeks.
Management of Acute Exacerbation
- Immediate intervention is crucial for life-threatening asthma exacerbations.
- Administer SABA and monitor response rapidly.
- High-dose oral corticosteroids or intravenous medications may be necessary if no improvement.
- Continuous monitoring and supportive care are essential for stabilization.
Asthma Exacerbation Management
- Peak Expiratory Flow Rate (PEFR) is used for acute management when Pulmonary Function Tests are impractical.
- Normal PEFR should exceed 70% of the predicted value based on age, gender, and height.
Patient Assessment
- Situation 1: If the patient improves post-SABA with peak flow likely >70%, discharge is appropriate.
- Situation 2: If peak flow is 50%-70% with no SABA improvement, further assessment and ABG analysis are warranted.
- ABG Analysis: Measures pH, pCO2, pO2, and bicarbonate levels; low pCO2 in hyperventilation indicates excessive CO2 exhalation.
Severe Exacerbation Indicators
- Situation 3: Elevated respiratory rate (20-25 breaths/min) and heart rate (>100 bpm); peak flow 25%-50% suggests severe asthma with expected abnormal ABG showing low pCO2.
- Situation 4: Peak expiratory flow <25% indicates critical condition; O2 saturation is likely low.
Asthma Classification and Treatment
-
Asthma is categorized based on the frequency of symptoms and FEV1 levels.
-
Intermittent Asthma:
- Daytime symptoms <2 times/week; nocturnal symptoms <3 times/month.
- FEV1 ≥ 80%.
- Treatment: Short-acting beta-2 agonist (SABA) as needed.
-
Mild Persistent Asthma:
- Daytime symptoms >2 times/week but <1 time/day; nighttime symptoms 3-4 times/month.
- FEV1 ≥ 80%.
- Treatment: SABA as needed + low-dose inhaled corticosteroids (ICS).
-
Moderate Persistent Asthma:
- Daily daytime symptoms; nighttime symptoms at least once/week.
- FEV1 between 60-80%.
- Treatment: SABA as needed + medium-dose ICS, or low-dose ICS + long-acting beta-2 agonists (LABA).
-
Severe Persistent Asthma:
- Daily symptoms; nighttime symptoms nightly.
- FEV1 < 60%.
- Treatment: SABA as needed + medium-dose ICS + LABA, or escalate to high-dose ICS + LABA. Oral corticosteroids may be necessary for severe cases.
Medication Mechanism of Action
-
SABA (e.g., Albuterol):
- Bronchodilation via beta-2 adrenergic receptor activation.
- Available as metered-dose inhaler, dry powder inhaler, or nebulizer.
- Side effects include tachyarrhythmias and tremors; contraindicated in patients with heart issues.
-
Inhaled Corticosteroids:
- Reduce inflammation by inhibiting cytokines and chemotaxis of white blood cells.
- Examples include fluticasone and budesonide.
- Risks include oral thrush; mouth rinsing is recommended after use.
-
LABA (e.g., Salmeterol, Formoterol):
- Long-acting; used with ICS, not alone for acute episodes.
- Associated with risks like tachyarrhythmias; use must be combined with ICS.
Alternative Treatment Options
-
Mast Cell Stabilizers:
- Example: Cromolyn sodium; prevents histamine release, effective for exercise or cold-induced asthma.
-
Leukotriene Receptor Antagonists:
- Example: Montelukast (Singulair); reduces bronchoconstriction and mucus production.
- Risks include potential mood changes and suicidal ideation.
-
Omalizumab:
- Anti-IgE treatment for severe allergic asthma; expensive and requires administration every 2-4 weeks.
Management of Acute Exacerbation
- Immediate intervention is crucial for life-threatening asthma exacerbations.
- Administer SABA and monitor response rapidly.
- High-dose oral corticosteroids or intravenous medications may be necessary if no improvement.
- Continuous monitoring and supportive care are essential for stabilization.
Asthma Exacerbation Management
- Peak Expiratory Flow Rate (PEFR) is used for acute management when Pulmonary Function Tests are impractical.
- Normal PEFR should exceed 70% of the predicted value based on age, gender, and height.
Patient Assessment
- Situation 1: If the patient improves post-SABA with peak flow likely >70%, discharge is appropriate.
- Situation 2: If peak flow is 50%-70% with no SABA improvement, further assessment and ABG analysis are warranted.
- ABG Analysis: Measures pH, pCO2, pO2, and bicarbonate levels; low pCO2 in hyperventilation indicates excessive CO2 exhalation.
Severe Exacerbation Indicators
- Situation 3: Elevated respiratory rate (20-25 breaths/min) and heart rate (>100 bpm); peak flow 25%-50% suggests severe asthma with expected abnormal ABG showing low pCO2.
- Situation 4: Peak expiratory flow <25% indicates critical condition; O2 saturation is likely low.
Asthma Classification and Treatment
-
Asthma is categorized based on the frequency of symptoms and FEV1 levels.
-
Intermittent Asthma:
- Daytime symptoms <2 times/week; nocturnal symptoms <3 times/month.
- FEV1 ≥ 80%.
- Treatment: Short-acting beta-2 agonist (SABA) as needed.
-
Mild Persistent Asthma:
- Daytime symptoms >2 times/week but <1 time/day; nighttime symptoms 3-4 times/month.
- FEV1 ≥ 80%.
- Treatment: SABA as needed + low-dose inhaled corticosteroids (ICS).
-
Moderate Persistent Asthma:
- Daily daytime symptoms; nighttime symptoms at least once/week.
- FEV1 between 60-80%.
- Treatment: SABA as needed + medium-dose ICS, or low-dose ICS + long-acting beta-2 agonists (LABA).
-
Severe Persistent Asthma:
- Daily symptoms; nighttime symptoms nightly.
- FEV1 < 60%.
- Treatment: SABA as needed + medium-dose ICS + LABA, or escalate to high-dose ICS + LABA. Oral corticosteroids may be necessary for severe cases.
Medication Mechanism of Action
-
SABA (e.g., Albuterol):
- Bronchodilation via beta-2 adrenergic receptor activation.
- Available as metered-dose inhaler, dry powder inhaler, or nebulizer.
- Side effects include tachyarrhythmias and tremors; contraindicated in patients with heart issues.
-
Inhaled Corticosteroids:
- Reduce inflammation by inhibiting cytokines and chemotaxis of white blood cells.
- Examples include fluticasone and budesonide.
- Risks include oral thrush; mouth rinsing is recommended after use.
-
LABA (e.g., Salmeterol, Formoterol):
- Long-acting; used with ICS, not alone for acute episodes.
- Associated with risks like tachyarrhythmias; use must be combined with ICS.
Alternative Treatment Options
-
Mast Cell Stabilizers:
- Example: Cromolyn sodium; prevents histamine release, effective for exercise or cold-induced asthma.
-
Leukotriene Receptor Antagonists:
- Example: Montelukast (Singulair); reduces bronchoconstriction and mucus production.
- Risks include potential mood changes and suicidal ideation.
-
Omalizumab:
- Anti-IgE treatment for severe allergic asthma; expensive and requires administration every 2-4 weeks.
Management of Acute Exacerbation
- Immediate intervention is crucial for life-threatening asthma exacerbations.
- Administer SABA and monitor response rapidly.
- High-dose oral corticosteroids or intravenous medications may be necessary if no improvement.
- Continuous monitoring and supportive care are essential for stabilization.
Asthma Exacerbation Management
- Peak Expiratory Flow Rate (PEFR) is used for acute management when Pulmonary Function Tests are impractical.
- Normal PEFR should exceed 70% of the predicted value based on age, gender, and height.
Patient Assessment
- Situation 1: If the patient improves post-SABA with peak flow likely >70%, discharge is appropriate.
- Situation 2: If peak flow is 50%-70% with no SABA improvement, further assessment and ABG analysis are warranted.
- ABG Analysis: Measures pH, pCO2, pO2, and bicarbonate levels; low pCO2 in hyperventilation indicates excessive CO2 exhalation.
Severe Exacerbation Indicators
- Situation 3: Elevated respiratory rate (20-25 breaths/min) and heart rate (>100 bpm); peak flow 25%-50% suggests severe asthma with expected abnormal ABG showing low pCO2.
- Situation 4: Peak expiratory flow <25% indicates critical condition; O2 saturation is likely low.
Asthma Classification and Treatment
-
Asthma is categorized based on the frequency of symptoms and FEV1 levels.
-
Intermittent Asthma:
- Daytime symptoms <2 times/week; nocturnal symptoms <3 times/month.
- FEV1 ≥ 80%.
- Treatment: Short-acting beta-2 agonist (SABA) as needed.
-
Mild Persistent Asthma:
- Daytime symptoms >2 times/week but <1 time/day; nighttime symptoms 3-4 times/month.
- FEV1 ≥ 80%.
- Treatment: SABA as needed + low-dose inhaled corticosteroids (ICS).
-
Moderate Persistent Asthma:
- Daily daytime symptoms; nighttime symptoms at least once/week.
- FEV1 between 60-80%.
- Treatment: SABA as needed + medium-dose ICS, or low-dose ICS + long-acting beta-2 agonists (LABA).
-
Severe Persistent Asthma:
- Daily symptoms; nighttime symptoms nightly.
- FEV1 < 60%.
- Treatment: SABA as needed + medium-dose ICS + LABA, or escalate to high-dose ICS + LABA. Oral corticosteroids may be necessary for severe cases.
Medication Mechanism of Action
-
SABA (e.g., Albuterol):
- Bronchodilation via beta-2 adrenergic receptor activation.
- Available as metered-dose inhaler, dry powder inhaler, or nebulizer.
- Side effects include tachyarrhythmias and tremors; contraindicated in patients with heart issues.
-
Inhaled Corticosteroids:
- Reduce inflammation by inhibiting cytokines and chemotaxis of white blood cells.
- Examples include fluticasone and budesonide.
- Risks include oral thrush; mouth rinsing is recommended after use.
-
LABA (e.g., Salmeterol, Formoterol):
- Long-acting; used with ICS, not alone for acute episodes.
- Associated with risks like tachyarrhythmias; use must be combined with ICS.
Alternative Treatment Options
-
Mast Cell Stabilizers:
- Example: Cromolyn sodium; prevents histamine release, effective for exercise or cold-induced asthma.
-
Leukotriene Receptor Antagonists:
- Example: Montelukast (Singulair); reduces bronchoconstriction and mucus production.
- Risks include potential mood changes and suicidal ideation.
-
Omalizumab:
- Anti-IgE treatment for severe allergic asthma; expensive and requires administration every 2-4 weeks.
Management of Acute Exacerbation
- Immediate intervention is crucial for life-threatening asthma exacerbations.
- Administer SABA and monitor response rapidly.
- High-dose oral corticosteroids or intravenous medications may be necessary if no improvement.
- Continuous monitoring and supportive care are essential for stabilization.
Asthma Exacerbation Management
- Peak Expiratory Flow Rate (PEFR) is used for acute management when Pulmonary Function Tests are impractical.
- Normal PEFR should exceed 70% of the predicted value based on age, gender, and height.
Patient Assessment
- Situation 1: If the patient improves post-SABA with peak flow likely >70%, discharge is appropriate.
- Situation 2: If peak flow is 50%-70% with no SABA improvement, further assessment and ABG analysis are warranted.
- ABG Analysis: Measures pH, pCO2, pO2, and bicarbonate levels; low pCO2 in hyperventilation indicates excessive CO2 exhalation.
Severe Exacerbation Indicators
- Situation 3: Elevated respiratory rate (20-25 breaths/min) and heart rate (>100 bpm); peak flow 25%-50% suggests severe asthma with expected abnormal ABG showing low pCO2.
- Situation 4: Peak expiratory flow <25% indicates critical condition; O2 saturation is likely low.
Asthma Classification and Treatment
-
Asthma is categorized based on the frequency of symptoms and FEV1 levels.
-
Intermittent Asthma:
- Daytime symptoms <2 times/week; nocturnal symptoms <3 times/month.
- FEV1 ≥ 80%.
- Treatment: Short-acting beta-2 agonist (SABA) as needed.
-
Mild Persistent Asthma:
- Daytime symptoms >2 times/week but <1 time/day; nighttime symptoms 3-4 times/month.
- FEV1 ≥ 80%.
- Treatment: SABA as needed + low-dose inhaled corticosteroids (ICS).
-
Moderate Persistent Asthma:
- Daily daytime symptoms; nighttime symptoms at least once/week.
- FEV1 between 60-80%.
- Treatment: SABA as needed + medium-dose ICS, or low-dose ICS + long-acting beta-2 agonists (LABA).
-
Severe Persistent Asthma:
- Daily symptoms; nighttime symptoms nightly.
- FEV1 < 60%.
- Treatment: SABA as needed + medium-dose ICS + LABA, or escalate to high-dose ICS + LABA. Oral corticosteroids may be necessary for severe cases.
Medication Mechanism of Action
-
SABA (e.g., Albuterol):
- Bronchodilation via beta-2 adrenergic receptor activation.
- Available as metered-dose inhaler, dry powder inhaler, or nebulizer.
- Side effects include tachyarrhythmias and tremors; contraindicated in patients with heart issues.
-
Inhaled Corticosteroids:
- Reduce inflammation by inhibiting cytokines and chemotaxis of white blood cells.
- Examples include fluticasone and budesonide.
- Risks include oral thrush; mouth rinsing is recommended after use.
-
LABA (e.g., Salmeterol, Formoterol):
- Long-acting; used with ICS, not alone for acute episodes.
- Associated with risks like tachyarrhythmias; use must be combined with ICS.
Alternative Treatment Options
-
Mast Cell Stabilizers:
- Example: Cromolyn sodium; prevents histamine release, effective for exercise or cold-induced asthma.
-
Leukotriene Receptor Antagonists:
- Example: Montelukast (Singulair); reduces bronchoconstriction and mucus production.
- Risks include potential mood changes and suicidal ideation.
-
Omalizumab:
- Anti-IgE treatment for severe allergic asthma; expensive and requires administration every 2-4 weeks.
Management of Acute Exacerbation
- Immediate intervention is crucial for life-threatening asthma exacerbations.
- Administer SABA and monitor response rapidly.
- High-dose oral corticosteroids or intravenous medications may be necessary if no improvement.
- Continuous monitoring and supportive care are essential for stabilization.
Asthma Exacerbation Management
- Peak Expiratory Flow Rate (PEFR) is used for acute management when Pulmonary Function Tests are impractical.
- Normal PEFR should exceed 70% of the predicted value based on age, gender, and height.
Patient Assessment
- Situation 1: If the patient improves post-SABA with peak flow likely >70%, discharge is appropriate.
- Situation 2: If peak flow is 50%-70% with no SABA improvement, further assessment and ABG analysis are warranted.
- ABG Analysis: Measures pH, pCO2, pO2, and bicarbonate levels; low pCO2 in hyperventilation indicates excessive CO2 exhalation.
Severe Exacerbation Indicators
- Situation 3: Elevated respiratory rate (20-25 breaths/min) and heart rate (>100 bpm); peak flow 25%-50% suggests severe asthma with expected abnormal ABG showing low pCO2.
- Situation 4: Peak expiratory flow <25% indicates critical condition; O2 saturation is likely low.
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Description
Explore the different classifications of asthma based on symptom frequency and FEV1 measurements. This quiz covers intermittent, mild persistent, moderate persistent, and severe persistent asthma, along with their respective treatments. Test your knowledge on how to identify and manage asthma effectively.