Asthma Diagnosis and Control

Asthma Diagnosis

• A diagnosis of asthma requires a patient's history of typical variable respiratory symptoms and confirmed variable expiratory airflow limitation.
• Variable expiratory airflow limitation can be documented through a bronchodilator reversibility test or other relevant tests.
• It is recommended to conduct these tests before starting treatment with inhaled corticosteroid (ICS)-containing medications.
• A diagnosis is more challenging to confirm after an asthma patient has experienced improvements in control.
• A bronchodilator reversibility test confirms asthma diagnosis through an increase in forced expiratory volume in one second (FEV1) greater than 200 mL and greater than 12% of baseline value or, in children, greater than 12% of predicted value.
• A FEV1 increase of more than 12% and 200 mL from baseline after four weeks of inflammatory treatment can also be used for diagnosis confirmation.

Assessing Asthma Control

• Evaluate asthma control every four weeks to assess symptom control.
• Regularly assess lung function and identify modifiable risk factors impacting outcomes.
• Measure lung function before starting treatment, three to six months after starting treatment, and periodically thereafter.

Identifying Risk Factors

• Assess risk factors at diagnosis and at least every one to two years, especially for those experiencing exacerbations.
• Record the patient's best lung function by measuring FEV1 at the beginning of treatment, after three to six months of controller treatment, and periodically throughout treatment.

Managing Asthma

• The long-term goal of asthma management is to reduce risk and control symptoms.
• General management principles include partnership between patient and healthcare provider, effective communication skills, and adequate patient health literacy.

Assessing Asthma Control in Adults and Adolescents

• For patients 12 years and older, confirm the asthma diagnosis if necessary.
• Identify and manage modifiable risk factors and comorbidities.
• Assess and improve inhaler technique and adherence.
• Address patient preferences and goals.
• Regularly assess and manage symptoms, exacerbations, and side effects.
• Implement non-pharmacological strategies.
• Adjust asthma medications based on assessment (stepping up, stepping down, or changing tracks) and ensure adequate education and skills training.

Asthma Management Tracks

• Track 1 uses ICS-formoterol as both controller and reliever, aimed at reducing exacerbations.
• Track 2 utilizes a controller medication, generally an ICS or other options, and a separate reliever medication, typically an inhaled short-acting beta2-agonist (SABA).
• Track 1 may be initiated by the patient if they have a written asthma action plan.

Asthma Management Steps

• Step 1
• Take an ICS whenever a SABA is used.
• Step 2
• Low-dose maintenance ICS.
• Step 3
• Low-dose maintenance ICS-LABA.
• Step 4
• Medium-dose or high-dose maintenance ICS-LABA, or add an LAMA or LTRA.
• Step 5
• Add-on LAMA or refer for assessment.

Stepping Down Asthma Treatment

• Consider stepping down treatment after three months of sustained good control.
• Aim to find the minimum effective dose that controls symptoms and exacerbations while minimizing side effects.
• Ensure good control for at least three months with stable lung function, no respiratory infections, the patient is not traveling, and the patient is not pregnant.
• Record symptoms, control levels, and relevant risk factors.
• Prepare a written asthma action plan and schedule a follow-up visit within one to three months.
• Consider reducing ICS doses by 25-50% every three months.
• Avoid entirely stopping ICS in adults with asthma due to the risk of exacerbation.

Treating Modifiable Risk Factors

• Encourage self-management, encompassing symptom and peak expiratory flow (PEF) monitoring, a written asthma action plan, and regular medical reviews.
• Prescribe medications that minimize exacerbations, specifically considering low-dose ICS-formoterol for patients with at least one exacerbation in the past year.
• Advocate for complete tobacco smoke avoidance (active and secondhand).
• Refer patients with severe asthma to a specialist center for consideration of add-on medications, sputum-guided treatment, and additional therapies.
• Implement appropriate food avoidance for individuals with confirmed food allergies.
• Ensure that patients with diagnosed food allergies have access to injectable epinephrine for anaphylaxis management.

Non-Pharmacological Interventions

• Encourage tobacco smoke avoidance, including environmental tobacco smoke exposure (e.g., homes and cars).
• Promote physical activity, emphasizing its overall health benefits.

This quiz covers the critical aspects of diagnosing asthma, including the importance of patient history, variable respiratory symptoms, and specific tests such as the bronchodilator reversibility test. Understand how to assess asthma control and the implications of treatment on diagnosis. Test your knowledge on recognizing and managing asthma effectively.