Podcast
Questions and Answers
What is the confirmed variable expiratory airflow limitation in asthma?
What is the confirmed variable expiratory airflow limitation in asthma?
FEV1/FVC is reduced, usually >0.75-0.80 in adults
For asthma, the initial controller treatment involves referring to the ______.
For asthma, the initial controller treatment involves referring to the ______.
sheet
Which of the following are common issues to assess before considering a step-up in asthma treatment? (Select all that apply)
Which of the following are common issues to assess before considering a step-up in asthma treatment? (Select all that apply)
Corticosteroids are recommended for outpatient use with pneumonia.
Corticosteroids are recommended for outpatient use with pneumonia.
Signup and view all the answers
What is RSV prevention administered to infants under 8 months entering their first RSV season?
What is RSV prevention administered to infants under 8 months entering their first RSV season?
Signup and view all the answers
Which antiviral is recommended for children 2 weeks and older?
Which antiviral is recommended for children 2 weeks and older?
Signup and view all the answers
Group A COPD patients with mMRC 0-1, CAT <=2 should receive a ______.
Group A COPD patients with mMRC 0-1, CAT <=2 should receive a ______.
Signup and view all the answers
What should the asthma action plan include?
What should the asthma action plan include?
Signup and view all the answers
ICS increases the risk for pneumonia in COPD patients.
ICS increases the risk for pneumonia in COPD patients.
Signup and view all the answers
What is the minimum duration for antibiotic treatment recommended for pneumonia?
What is the minimum duration for antibiotic treatment recommended for pneumonia?
Signup and view all the answers
What are the components to assess in personalized asthma management?
What are the components to assess in personalized asthma management?
Signup and view all the answers
Using ICS-formoterol as a reliever reduces the risk of exacerbations compared to using a SABA reliever.
Using ICS-formoterol as a reliever reduces the risk of exacerbations compared to using a SABA reliever.
Signup and view all the answers
What should be done before considering a regimen with SABA reliever?
What should be done before considering a regimen with SABA reliever?
Signup and view all the answers
The preferred reliever for Track 1 is __________.
The preferred reliever for Track 1 is __________.
Signup and view all the answers
Match the asthma treatment steps with their descriptions:
Match the asthma treatment steps with their descriptions:
Signup and view all the answers
Consider high dose __________ when adding treatments.
Consider high dose __________ when adding treatments.
Signup and view all the answers
Which of the following are alternative reliever options mentioned?
Which of the following are alternative reliever options mentioned?
Signup and view all the answers
What is the first step in controller treatment for patients with asthma who have symptoms less than twice a month?
What is the first step in controller treatment for patients with asthma who have symptoms less than twice a month?
Signup and view all the answers
Which treatment step corresponds to patients experiencing symptoms most days or waking with asthma once a week or more?
Which treatment step corresponds to patients experiencing symptoms most days or waking with asthma once a week or more?
Signup and view all the answers
A patient with asthma symptoms occurring twice a month should start at Step 2.
A patient with asthma symptoms occurring twice a month should start at Step 2.
Signup and view all the answers
What should be assessed in patients before starting controller treatment for asthma?
What should be assessed in patients before starting controller treatment for asthma?
Signup and view all the answers
What is a preferred reliever for patients prescribed maintenance and reliever therapy?
What is a preferred reliever for patients prescribed maintenance and reliever therapy?
Signup and view all the answers
Low-dose ICS-form is the reliever only for patients prescribed __________.
Low-dose ICS-form is the reliever only for patients prescribed __________.
Signup and view all the answers
Which of the following is NOT listed as a component of the preferred controller options for asthma?
Which of the following is NOT listed as a component of the preferred controller options for asthma?
Signup and view all the answers
What additional therapy may be added for patients with low lung function?
What additional therapy may be added for patients with low lung function?
Signup and view all the answers
What is a preferred controller to prevent exacerbations in children with asthma?
What is a preferred controller to prevent exacerbations in children with asthma?
Signup and view all the answers
Daily low dose inhaled corticosteroid (ICS) is recommended for all children with asthma.
Daily low dose inhaled corticosteroid (ICS) is recommended for all children with asthma.
Signup and view all the answers
What should be assessed during the management of a child's asthma?
What should be assessed during the management of a child's asthma?
Signup and view all the answers
The short-acting medication used as a reliever for asthma is called a __________.
The short-acting medication used as a reliever for asthma is called a __________.
Signup and view all the answers
Which of the following are modifiable risk factors in asthma management? (Select all that apply)
Which of the following are modifiable risk factors in asthma management? (Select all that apply)
Signup and view all the answers
What is a non-pharmacological strategy for managing asthma?
What is a non-pharmacological strategy for managing asthma?
Signup and view all the answers
Match the following steps with their description in asthma medication management:
Match the following steps with their description in asthma medication management:
Signup and view all the answers
What should be confirmed first in the assessment of a child with asthma?
What should be confirmed first in the assessment of a child with asthma?
Signup and view all the answers
If a child has symptoms most days and low lung function, a medium dose ICS-LABA should be started.
If a child has symptoms most days and low lung function, a medium dose ICS-LABA should be started.
Signup and view all the answers
What should be initiated if a child has symptoms most days or wakes at night at least once a week?
What should be initiated if a child has symptoms most days or wakes at night at least once a week?
Signup and view all the answers
What is the treatment step for children with asthma who have symptoms twice a month or more?
What is the treatment step for children with asthma who have symptoms twice a month or more?
Signup and view all the answers
A child with asthma who has symptoms less than twice a month does not need any daily medication.
A child with asthma who has symptoms less than twice a month does not need any daily medication.
Signup and view all the answers
A short course of ______ may also be needed for patients presenting with severely uncontrolled asthma.
A short course of ______ may also be needed for patients presenting with severely uncontrolled asthma.
Signup and view all the answers
Study Notes
Asthma
- Diagnosing asthma involves:
- History of respiratory symptoms that vary in time and intensity, occurring or worsening at night, when walking, or triggered by exercise, laughter, allergens, or cold air
- Confirmed variable expiratory airflow limitation, with FEV1 reduction and FEV1/FVC ratio usually >0.75-0.80 in adults
- Documented excessive variability in lung function
- Shared decision making involves:
- Inhaler skills and adherence
- Written asthma action plan
- Self-monitoring of symptoms and/or peak flow
- Regular medical review
- Non-pharmacological interventions include:
- Smoking cessation
- Physical activity
- Investigation for occupational asthma
- Identification of aspirin-exacerbated respiratory disease
- Initial controller therapy:
- Sustained step-up for at least 2-3 months
- Short-term step-up for 1-2 weeks
- Day-to-day adjustment by the patient
- Stepping down asthma therapy:
- Considered once good asthma control has been achieved and maintained for 3 months
- Aim to find the lowest therapy that controls symptoms and exacerbations while minimizing side effects
- Treating exacerbations:
- Acute or sub-acute worsening of symptoms and lung function from the patient's usual status
- Oral corticosteroids (preferably morning dose) for 5-7 days
- Tapering not needed if OCS has been given for less than 2 weeks
- Stepwise approach for children under 5:
- Step 1: As-needed inhaled SABA
- Step 2: Low-dose ICS daily plus SABA as needed or daily LTRA + SABA as needed
- Step 3: Double low-dose ICS + SABA as needed or low-dose ICS + LTRA
- Step 4: Continue controller and refer to specialist for assessment
COPD
- Group E (exacerbation): those with ≥2 moderate exacerbations or ≥1 leading to hospitalization
- LABA + LAMA (consider LABA+LAMA+ICS if blood eosinophil ≥300)
- ICS increases risk of pneumonia in these patients
- For those with 0 or 1 moderate exacerbations (not leading to hospital admission):
- Group A: Bronchodilator (LABA) with mMRC 0-1, CAT ≤2, CAT ≥10
Community-Acquired Pneumonia
- Adults:
- Viral causes including influenza
- Bacterial causes including streptococcus, Haemophilus influenzae, Staphylococcus aureus, Mycoplasma, Chlamydia, and Legionella
- Outpatient treatment:
- For healthy adults without comorbidities or risk factors for antibiotic-resistant pathogens:
- Amoxicillin 1g three times daily or
- Doxycycline 100mg twice daily
- For healthy adults without comorbidities or risk factors for antibiotic-resistant pathogens:
- High-risk individuals:
- Combination therapy:
- Amoxicillin/clavulanate or Cephalosporin
- AND Macrolide (azithromycin or clarithromycin) or Doxycycline
- Or monotherapy: respiratory fluoroquinolone (floxacin)
- Combination therapy:
- How to choose an agent:
- Consider recent antibiotic use and choose a different class
- Duration of treatment:
- Minimum of 5 days
- Patients should be afebrile and clinically stable for 48-72 hours before stopping
RSV
- Nirsevimab:
- A monoclonal antibody for infants under 8 months entering their first RSV season (October-March) not vaccinated
- Children up to 24 months who remain at risk of severe RSV disease through their second season
- Vaccinating pregnant people (32-36 weeks) generally means the baby will not need Nirsevimab
- Palivizumab:
- A monoclonal antibody produced by recombinant DNA
- Used for RSV prevention in infants/children at high risk for severe RSV disease
- Noted reduced RSV disease hospitalization rate by up to 55%
- Provides passive immunity, plays no role in treating acute RSV, and is FDA-approved for adults at high risk for severe RSV
- RSV Vaccination:
- Provides protection against RSV
- Models:
- Direct immunization of at-risk adults
- Immunize during pregnancy (especially in adults ≥60 years)
Flu
- Antiviral therapy:
- Does not treat the virus but helps prevent mortality and hospitalizations
- Recommend for anyone exposed to flu or has flu
- Management:
- Antivirals:
- Oseltamivir (children 2 weeks and older)
- Zanamivir (children 7 and older)
- Peramivir (children 2 and older, IV only)
- Baloxavir (children 5-12, not for pregnant or lactating women)
- Antivirals:
- Empiric treatment most effective within 24 hours
- For outpatients with suspected or confirmed uncomplicated influenza:
- Oral oseltamivir or inhaled zanamivir or oral baloxavir
COVID-19
- Preferred therapies:
- With + SARS test, eligible adults, and pediatrics patients at risk for severe COVID-19:
- Ritonavir-boosted nirmatrelvir PO (start within 5 days of symptom onset for 5 days)
- Remdesivir IV (start within 7 days of symptom onset for 3 days)
- Alternative therapies: bebtelovimab and molnupriravir
- With + SARS test, eligible adults, and pediatrics patients at risk for severe COVID-19:
Allergic Rhinitis
- Three classes of drugs are utilized:
- Glucocorticoids (intranasal):
- Best for both seasonal and perennial rhinitis
- Examples: budesonide, fluticasone propionate (flonase), and triamcinolone
- Adverse effects: nasal mucosa drying, burning/itching, sore throat, epistaxis
- Antihistamines (oral and intranasal):
- First line for mild-moderate allergic rhinitis
- Most effective when taken prophylactically
- Examples:
- Ethanolamines (diphenhydramine) and phenothiazines (promethazine)
- Alkylamines (chlorpheniramine) only modest reduction in alertness
- Fexofenadine (reduce dose for renal impairment)
- Intranasal: azelastine and olopatadine
- Sympathomimetics (oral and intranasal):
- Only relieve congestion
- Adverse effects: rebound congestion when used > a few days
- Examples:
- Phenylephrine (oral and nasal)
- Pseudoephedrine (oral)
- Glucocorticoids (intranasal):
Personalized Asthma Management
- Assess and adjust treatment based on individual patient needs, considering:
- Symptoms
- Exacerbations
- Side-effects
- Lung function
- Patient satisfaction
Confirmation of Diagnosis
- Verify diagnosis by considering:
- Symptom control and modifiable risk factors
- Lung function
- Comorbidities
- Inhaler technique and adherence
- Patient preferences and goals
Treatment of Modifiable Risk Factors and Comorbidities
- Implement non-pharmacological strategies
- Adjust asthma medications (up, down, or between tracks)
- Provide education and skills training
Controller and Preferred Reliever (Track 1)
- Using ICS-formoterol as reliever reduces exacerbation risk compared to SABA reliever
- Treatment steps:
- As-needed low-dose ICS-formoterol (Steps 1-2)
- Low-dose maintenance ICS-formoterol (Step 3)
- Medium-dose maintenance ICS-formoterol (Step 4)
- Add-on LAMA, refer for phenotypic assessment ± anti-IgE, anti-IL5/5R, anti-IL4R, consider high-dose ICS-formoterol (Step 5)
Controller and Alternative Reliever (Track 2)
- Before considering SABA reliever, ensure patient is likely to adhere to daily controller
- Alternative controller options for either track
- Reliever options:
- As-needed short-acting β2-agonist (Steps 1-5)
- Take ICS whenever SABA taken (Step 1)
- Low-dose maintenance ICS (Step 2)
- Low-dose maintenance ICS-LABA (Step 3)
- Medium/high-dose maintenance ICS-LABA (Step 4)
- Add-on LAMA, refer for phenotypic assessment ± anti-IgE, anti-IL5/5R, anti-IL4R, consider high-dose ICS-LABA (Step 5)
Assessing Asthma Patients
- Diagnosis confirmation is necessary
- Assess symptom control, modifiable risk factors, and lung function
- Identify comorbidities and evaluate inhaler technique and adherence
- Consider patient preferences and goals
Initial Treatment Steps
- Mild Symptoms (<2 times a month): As-needed low dose ICS-formoterol (Step 1)
- Moderate Symptoms (≥2 times a month, but < daily): Daily low dose inhaled corticosteroid (ICS) or as-needed low dose ICS-formoterol (Step 2)
- Daily Symptoms, or Waking with Asthma ≥1 time a week: Low dose ICS-LABA (Step 3)
- Daily Symptoms, Waking with Asthma ≥1 time a week, and Low Lung Function: Medium dose ICS-LABA (Step 4)
- Severe Symptoms: High dose ICS-LABA and consider referring for phenotypic assessment and add-on therapy (Step 5)
Preferred Controllers
- As-needed low dose ICS-formoterol to prevent exacerbations and control symptoms
- Low dose ICS taken whenever SABA is taken
- Daily leukotriene receptor antagonist (LTRA) as an alternative controller option
Preferred Relievers
- As-needed low dose ICS-formoterol for patients prescribed maintenance and reliever therapy
- As-needed short-acting β²-agonist (SABA) as an alternative reliever option
Personalized Asthma Management in Children 6-11 Years
Asthma Medication Options
- Adjust treatment up and down for individual child's needs based on symptoms, side-effects, lung function, and child and parent satisfaction
- Medication options include:
- Step 1: PREFERRED CONTROLLER to prevent exacerbations and control symptoms
- Step 2: Daily low dose inhaled corticosteroid (ICS) with dose ranges varying for children
- Step 3: Low dose ICS-LABA or medium dose ICS
- Step 4: Medium dose ICS-LABA, with referral for expert advice
- Step 5: Referral for phenotypic assessment and add-on therapy, such as anti-IgE
-
Other Controller Options:
- Low dose ICS taken whenever SABA taken or daily low dose ICS
- Daily leukotriene receptor antagonist (LTRA), or low dose ICS taken whenever SABA taken
- RELIEVER: As-needed short-acting β2β_2β2-agonist (SABA) using separate ICS and SABA inhalers
Assess
- Confirmation of diagnosis if necessary
- Symptom control and modifiable risk factors, including:
- Lung function
- Comorbidities
- Inhaler technique
- Adherence
- Child and parent preferences and goals
Adjust
- Treatment of modifiable risk factors and comorbidities
- Non-pharmacological strategies
- Asthma medications (adjust down or up)
- Education and skills training
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Related Documents
Description
This quiz covers the diagnosis and management of asthma, including signs and symptoms, trigger factors, and lung function tests.
