Asthma Monitoring and Peak Flow Measurement Quiz

Monitoring and Peak Expiratory Flow

• Optimal management of patients can reduce symptoms, including nocturnal and early morning onsets
• Peak expiratory flow (PEF) measurement has a green zone (80-100%) and a yellow zone (50-79%)
• Proper use of PEF meter: stand while using, position indicator at the bottom of the scale, hold meter without blocking the opening, inhale deeply, place mouthpiece in mouth, and blow out as fast and as hard as possible

Drug-Drug and Drug-Disease Interactions

• Zafirlukast administration with meals decreases bioavailability; take 1 or 2 hours before meals
• Zileuton and zafirlukast may increase warfarin's effect and theophylline levels
• Inducers of CYP450: erythromycin, clarithromycin, itraconazole, oral contraceptives, and conjugated estrogen

Parameters to Monitor

• Refill record for daily controller medication and quick relief medications
• Reduction in symptoms
• Emergency department visits and hospitalizations
• Need for “bursts” of systemic corticosteroids
• PEF monitoring

Corticosteroids

• Suppress inflammation and decrease airway hyper responsiveness
• Systemic corticosteroids: improvement in PFT in 1-3 hours, maximum effect in 6-9 hours
• Examples: prednisone, prednisolone, methylprednisolone, beclomethasone, betamethasone, dexamethasone, hydrocortisone, triamcinolone
• IV corticosteroids: given to patients who cannot take oral medications
• Oral corticosteroids: prednisone and prednisolone
• Inhaled corticosteroids: preferred anti-inflammatory therapy for chronic asthma
• Examples: beclomethasone, budesonide, flunisolide, fluticasone, mometasone, triamcinolone
• May affect: child growth, vitamin D, fungal infection

Leukotriene Inhibitors

• Zafirlukast, montelukast, pranlukast, and zileuton: considered as second-line agents
• Precautions and monitoring effects: Churg-Strauss Syndrome associated with zafirlukast, montelukast, pranlukast
• Zileuton: LOX inhibitor, C/I with severe hepatic function

Cromolyn

• Stabilizing mast cells and inhibiting mast cell degranulation
• Nedocromil and cromolyn MDI has been removed from the market
• Cromolyn is less effective in its anti-inflammatory properties than inhaled steroids

Theophylline Compounds

• Used if beta agonists and corticosteroids fail to control asthma
• Induced phosphodiesterase inhibition results in increased levels of cAMP
• Contraindicated to patients with hypersensitivity, special precautions for hepatic diseases, hypoxemia, hypertension, CHF, alcoholism, and elderly

Anticholinergics

• Ipratropium bromide: treatment for acute asthma exacerbation in the emergency department or hospital setting
• Should not be used alone to treat an asthma exacerbation

Other Drugs Used for Asthma Management

• Antihistamines
• Antibiotics
• Magnesium sulfate
• Immunotherapy
• Omalizumab