Asthma Treatment and Management

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Questions and Answers

What is the primary goal when stepping down asthma controller treatment?

To switch to a different medication class

To increase patient autonomy in adjusting medication doses

To rapidly reduce medication costs

To find the lowest dose that controls symptoms and exacerbations, and minimizes the risk of side-effects (correct)

When considering stepping down asthma controller treatment, what should be recorded?

Only the patient's medication regimen

Only symptom control levels

Only lung function measurements

The level of symptom control and risk factors (correct)

What is recommended for patients with ≥1 exacerbations in the previous year?

Low-dose ICS/formoterol maintenance and reliever regimen (correct)

Tiotropium add-on therapy

High-dose ICS monotherapy

Adrenaline injection only

According to the guidelines, what should be avoided in patients with severe asthma?

Tobacco smoke exposure Signup and view all the answers

What is the recommended approach to stepping down ICS doses?

Reduce by 25–50% every 3 months Signup and view all the answers

What is an important component of guided asthma self-management?

Self-monitoring of symptoms and/or PEF, a written asthma action plan, and regular medical review Signup and view all the answers

What should be referred to a specialist center, if available, for consideration of add-on medications and/or sputum-guided treatment?

Patients with severe asthma Signup and view all the answers

What is recommended for patients with confirmed food allergy?

Appropriate food avoidance and ensure availability of injectable epinephrine for anaphylaxis Signup and view all the answers

What is a non-pharmacological intervention for asthma management?

Avoidance of tobacco smoke exposure Signup and view all the answers

What is discouraged in adults with asthma due to the risk of exacerbations?

Stopping ICS Signup and view all the answers

What is an essential aspect of the stepwise approach to control asthma symptoms and reduce risk?

Inhaler technique assessment Signup and view all the answers

What is the primary goal of a step-up therapy in asthma management?

To reduce the frequency of exacerbations Signup and view all the answers

Which of the following is a non-pharmacological strategy for asthma management?

Treat modifiable risk factors Signup and view all the answers

What is an important consideration when developing an asthma action plan?

Patient's inhaler technique and adherence Signup and view all the answers

What is a potential systemic side-effect of inhaled corticosteroids (ICS) in asthma management?

Oropharyngeal candidiasis Signup and view all the answers

When is a step-down therapy considered in asthma management?

When lung function improves Signup and view all the answers

What is the preferred controller choice in the stepwise approach to asthma management?

Inhaled corticosteroids Signup and view all the answers

Which of the following is a factor to consider when adjusting ICS dosing in asthma management?

Patient's symptom severity Signup and view all the answers

What is an essential aspect of patient education in the stepwise approach to asthma management?

Inhaler technique demonstration Signup and view all the answers

What is the primary goal of assessing lung function in asthma management?

To monitor treatment efficacy Signup and view all the answers

What is the first step to consider when thinking about stepping up asthma treatment?

Check for correct inhaler technique Signup and view all the answers

In which patients with allergic rhinitis is adding SLIT considered?

Adult patients with exacerbations despite ICS treatment and FEV1 > 70% predicted Signup and view all the answers

What is the recommended approach when symptoms are controlled for 3 months?

Step down asthma treatment Signup and view all the answers

What should be advised about non-pharmacological therapies?

Advise about physical activity, weight loss, and avoidance of sensitizers Signup and view all the answers

What should be treated in asthma management?

Comorbidities and modifiable risk factors Signup and view all the answers

What should be checked before stepping up asthma treatment?

Diagnosis and inhaler technique Signup and view all the answers

If a patient's symptoms are not typical of asthma, what should be done next?

Further history and tests for alternative diagnoses Signup and view all the answers

What is the next step if the results of spirometry/PEF with reversibility test support asthma diagnosis?

Confirm asthma diagnosis Signup and view all the answers

What is the primary goal of the initial evaluation in asthma diagnosis?

To rule out alternative diagnoses Signup and view all the answers

When is a detailed history/examination for asthma warranted?

When symptoms are typical of asthma Signup and view all the answers

What is the purpose of further history and tests for alternative diagnoses?

To rule out alternative diagnoses Signup and view all the answers

When can a patient's symptoms be considered controlled?

When symptoms are under control for 3 months Signup and view all the answers

What is the next step if the results of spirometry/PEF with reversibility test do not support asthma diagnosis?

Arrange other tests Signup and view all the answers

What is the main goal of the initial evaluation in asthma diagnosis?

To rule out alternative diagnoses Signup and view all the answers

What is the primary goal when assessing a patient's cough?

To determine the underlying cause of the cough Signup and view all the answers

Which of the following is a geriatric specific consideration in pulmonary disease management?

Cerumen impaction Signup and view all the answers

What is a common complaint associated with pulmonary disease?

Dyspnea Signup and view all the answers

Which of the following is a differential diagnosis for cough?

All of the above Signup and view all the answers

What is a characteristic of a productive cough?

It produces mucus or phlegm Signup and view all the answers

What is a major player in pulmonary disease management?

Asthma Signup and view all the answers

What is the primary reason for checking adherence to asthma medications?

To reduce the risk of uncontrolled asthma symptoms and exacerbations Signup and view all the answers

What is the estimated percentage of adults and children who do not take controller medications as prescribed?

50% Signup and view all the answers

What is a recommended approach to identify patients with low adherence to asthma medications?

Ask an empathic question about adherence Signup and view all the answers

What is a common factor contributing to poor adherence to asthma medications?

All of the above Signup and view all the answers

What is the recommended approach to improve inhaler technique?

Demonstrate the correct technique Signup and view all the answers

How often should inhaler technique be re-checked?

Every 4-6 weeks Signup and view all the answers

What is the benefit of brief inhaler technique training?

Improved asthma control Signup and view all the answers

What should be avoided when prescribing ICS by pMDI?

Using multiple different inhaler types Signup and view all the answers

What is the main difference between atypical pneumonia and pneumococcal pneumonia?

Atypical pneumonia is more common in persons under 40 years old Signup and view all the answers

What is the indication for pulse oximetry screening in community-acquired pneumonia (CAP)?

Suspect pneumonia Signup and view all the answers

What is the recommended duration of therapy for community-acquired pneumonia (CAP) in severe cases?

10-14 days Signup and view all the answers

What is the most common cause of chronic cough?

Postnasal drip Signup and view all the answers

What is the definition of chronic bronchitis?

Cough and sputum production for at least 3 months in 2 consecutive years Signup and view all the answers

What is the diagnostic test of choice for obstructive sleep apnea (OSA)?

Polysomnogram (PSG) Signup and view all the answers

What is a consequence of untreated obstructive sleep apnea (OSA)?

All of the above Signup and view all the answers

What is the recommended approach to managing chronic cough in geriatric patients?

All of the above Signup and view all the answers

What is a common misperception about older people with respiratory symptoms?

They tend to overestimate their symptoms Signup and view all the answers

What is the recommended approach to diagnosing and treating rhinosinusitis in geriatric patients?

The same approach as in younger patients Signup and view all the answers

What is the frequency of night time symptoms that may indicate the need for an ICS as a controller?

More than twice a month Signup and view all the answers

What is the primary consideration when choosing between treatment options at a population level?

Cost and availability at the population level Signup and view all the answers

In individual patient decisions, what is an important consideration when discussing treatment options?

Patient characteristics and phenotype Signup and view all the answers

What is the frequency of cannister use of a rescue medication that may indicate the need for an ICS as a controller?

More than two cannisters in a year Signup and view all the answers

What is an important consideration when choosing between controller options for an individual patient?

All of the above Signup and view all the answers

What is the basis for the 'preferred treatment' at each step in the guidelines?

Efficacy and effectiveness based on group mean data Signup and view all the answers

Why is it important to consider the patient's phenotype when choosing between controller options?

Because it affects the patient's response to treatment Signup and view all the answers

What is the primary goal of considering the patient's goals and concerns for their asthma?

To improve patient engagement and adherence Signup and view all the answers

What is the estimated percentage of people ≥65 years who meet the criteria for asthma?

5%-10% Signup and view all the answers

What is the primary cause of wheezing in 'cardiac asthma'?

Heart failure Signup and view all the answers

What is the median survival time for patients with idiopathic pulmonary fibrosis?

3-5 years Signup and view all the answers

What is the recommended approach for treating sleep apnea?

All of the above Signup and view all the answers

What is the leading cause of death in older adults with COPD?

COPD itself Signup and view all the answers

What is the primary benefit of smoking cessation in older adults with COPD?

Slowing down the decline in lung function Signup and view all the answers

What is the estimated number of people affected by asthma worldwide?

300 million Signup and view all the answers

What is a common complication of obstructive sleep apnea?

All of the above Signup and view all the answers

What is the primary goal of asthma management in older adults?

Prevention of exacerbations Signup and view all the answers

What is a characteristic of idiopathic pulmonary fibrosis?

Clubbing is often a prominent finding Signup and view all the answers

What is the main difference between the symptoms of Mycoplasma pneumoniae and Streptococcus pneumoniae in older adults?

Mycoplasma pneumoniae presents with a more subtle onset of symptoms, while Streptococcus pneumoniae presents with a more sudden onset of symptoms Signup and view all the answers

What is the recommended approach to the management of chronic cough in older adults?

Empiric treatment for GERD, asthma, and postnasal drip, and then re-evaluate Signup and view all the answers

What is the primary goal of the CURB-65 mortality prediction tool in patients with community-acquired pneumonia (CAP)?

To predict the risk of mortality Signup and view all the answers

What is the recommended approach to the management of obstructive sleep apnea (OSA) in older adults?

Avoidance of alcohol, sedatives, and hypnotics, and weight loss, in addition to positive airway pressure (PAP) therapy Signup and view all the answers

What is the primary difference between the management of community-acquired pneumonia (CAP) in inpatients and outpatients?

The use of antibiotics with a broader spectrum of activity in inpatients Signup and view all the answers

What is the recommended approach to the evaluation of a single pulmonary nodule in an older adult?

Review of previous imaging studies, and then follow-up with serial imaging studies Signup and view all the answers

What is the primary goal of the diagnostic approach to chronic cough in older adults?

To identify the underlying cause of the cough, and then develop an empiric treatment plan Signup and view all the answers

What is the recommended approach to the management of wheezing in older adults?

Empiric treatment for asthma, and then re-evaluate Signup and view all the answers

What is the primary difference between the management of community-acquired pneumonia (CAP) in younger adults and older adults?

The consideration of age-related changes in lung function and underlying co-morbidities in older adults Signup and view all the answers

What is the primary goal of the follow-up evaluation in patients with community-acquired pneumonia (CAP)?

To evaluate the response to treatment, and then adjust the treatment plan as necessary Signup and view all the answers

Study Notes

Initiating Asthma Treatment

May be initiated by a patient with a written asthma action plan
Day-to-day adjustment for patients prescribed low-dose ICS/formoterol maintenance and reliever regimen

Stepping Down Asthma Treatment

Consider stepping down after good control maintained for 3 months
Aim to find each patient's minimum effective dose that controls symptoms and exacerbations
Stepping down ICS doses by 25-50% at 3-month intervals is feasible and safe for most patients
Stopping ICS is not recommended in adults with asthma due to the risk of exacerbations

General Principles for Stepping Down

Aim to find the lowest dose that controls symptoms and exacerbations, and minimizes the risk of side-effects
Consider stepping down when symptoms have been well controlled and lung function stable for ≥3 months
Prepare for step-down by recording symptom control, considering risk factors, and booking a follow-up visit

Treating Modifiable Risk Factors

Provide skills and support for guided asthma self-management
Prescribe medications or regimens that minimize exacerbations, such as ICS-containing controller medications
Encourage avoidance of tobacco smoke and provide smoking cessation advice and resources
For patients with severe asthma, refer to a specialist center for consideration of add-on medications and/or sputum-guided treatment
For patients with confirmed food allergy, ensure appropriate food avoidance and availability of injectable epinephrine for anaphylaxis

Non-pharmacological Interventions

Avoidance of tobacco smoke exposure is crucial, provide advice and resources at every visit
Encourage physical activity due to its general health benefits

Stepwise Approach to Control Asthma Symptoms and Reduce Risk

Diagnosis, symptom control, and risk factors should be considered
Inhaler technique and adherence, patient preference, and lung function should be evaluated
Non-pharmacological strategies and treatment of modifiable risk factors are essential
Referral for add-on treatment and consideration of stepping up or down should be considered based on patient response

Pulmonary Disease Management

Pulmonary disease management involves understanding common complaints, geriatric specific considerations, and the major players in the disease.

Common Complaints

Cough is a common complaint, with differential diagnoses including prescription drugs, cerumen impaction, post nasal drip, COPD, asthma, postinfection, GERD, and occupational or environmental factors.
Dyspnea is a common complaint, with underlying causes to be identified.
Hemoptysis is a common complaint, with underlying causes to be identified.

Cough

A thorough history is necessary to diagnose the cause of a cough, including:
- When did it begin?
- When does it occur?
- What stimulates it/aggravates it?
- What makes it better?
- Describe the quality (productive or nonproductive?)
Cough can be a symptom of various conditions, including URIs, acute and chronic bronchitis, pneumonia, single pulmonary nodule, and obstructive sleep apnea.

The Major Players

Asthma is a major player in pulmonary disease management.
COPD is a major player in pulmonary disease management.### Pneumonia
Common causes of pneumonia: Influenzae, Moraxella catarrhalis, Staph aureus, Anaerobes, Group A strep, Immunocompromised—CMV or PCP, M.catarrhalis
Pneumococcal pneumonia: S pneumoniae (gram +), abrupt onset, productive cough with rusty colored sputum, fever, chills, pleuritic chest pain, more subtle in older patients
Atypical pneumonia: Mycoplasma pneumoniae, headache, sore throat, myalgia, dry hacking cough, most common in persons under 40, may be clinically indistinguishable from pneumococcal pneumonia

Differences in Presentation

Mycoplasma pneumonia: sore throat, fever, dry hacking cough, complications include sinusitis, OM, erythema multiforme, intravascular hemolysis, meningoencephalitis, toxic psychosis, myocarditis or pericarditis
Chlamydia pneumonia: biphasic illness, younger individuals, severe pharyngitis and laryngitis, fever, cough

Physical Exam

No specific signs can confirm pneumonia
PE cannot reliably distinguish type of pneumonia
Tachypnea is more common in older adults
Pulse oximetry screening should be performed if suspect CAP
Fever, increased tactile fremitus, dullness to percussion, egophony, crackles (rales), bronchial breath sounds

Diagnostic Testing

CXR required to differentiate
Normal CXR does not exclude diagnosis
Pulse ox, CBC with diff, electrolytes, rapid test for influenza may be helpful
Additional testing is indicated in those severely ill, those immunosuppressed, and those HIV+

CAP Ambulatory Treatment

Hydration, respiratory hygiene, ASA or acetaminophen for fever & HA, smoking cessation, prevention—pneumococcal & influenza vaccine
Empiric treatments: azithromycin, clarithromycin, doxycycline, levofloxacin, moxifloxacin, beta-lactam, combination of beta-lactam and macrolide

CAP Inpatient Treatment

Combination of beta-lactam and macrolide, or fluoroquinolone
ICU: combination of beta-lactam and macrolide or fluoroquinolone
Duration of therapy: minimum 5 days, should be afebrile for 48-72 hours, stable BP, adequate oral intake, and room air O2 sat >90%

Mortality Prediction Tool

CURB-65: confusion, urea, respiratory rate, blood pressure, age > 65

Follow-up

Telephone follow-up in 24 hours
Office visit in 3-4 days
Reassure cough and fatigue may last 3-4 weeks
Repeat CXR in 2 weeks for young adults, 4-6 weeks for smokers and older adults, 8 weeks for frail elderly

Chronic Cough

Subacute cough: lasting 3-8 weeks
Chronic cough: persisting beyond 8 weeks
Most common causes: postnasal drip, GERD, asthma
Differential diagnoses: cigarette smoking, postnasal drip, allergies, chronic sinusitis, bronchospasm, CHF, impacted cerumen or other foreign body, bronchogenic tumors, chronic pulmonary infections, hematological, inflammation, psychogenic

Bronchiectasis

Chronic cough, overproduction of secretions, reduced clearance of secretions
Excess airway secretions, chronic pulmonary infections, bronchogenic tumors, chronic aspiration

Sleep Apnea

Pause in breathing for 10-90 seconds
Central apneas: absent airflow and respiratory efforts, neurological diseases
Obstructive apneas: tongue and soft palate fall backward, mixed apneas
Consequences: pulmonary HTN, HTN with LV dysfunction, cardiac dysrhythmias, psychomotor defects, hypoxia and hypercapnia

Management

General measures: avoidance of alcohol, sedatives, hypnotics, weight loss, O2 therapy, nasal dilators
Specific measures: position therapy, positive airway pressure, oral appliances, surgical management

Geriatric Specific Considerations

Age-related pulmonary changes: reduced airway size, shallow alveolar sacs, decline in chest wall compliance, intercostal muscle atrophy, reduction in diaphragmatic strength
Difficulties in recognizing respiratory symptoms: older people tend to underreport or underestimate respiratory symptoms
Multiple causes of respiratory problems: asthma, COPD, heart failure, GERD
Rhinosinusitis: treat bacterial rhinosinusitis with analgesics, saline irrigation, and antibiotics, treat chronic rhinosinusitis with topical nasal steroids and saline irrigation
Dyspnea: common causes include COPD, cardiac disease, asthma, interstitial lung disease, deconditioning
Wheezing: most common causes are asthma, COPD, heart failure### Indicators for ICS as a Controller
Symptoms more than twice a day
Night time symptoms more than twice a month
Severe asthma requiring emergency treatment or oral steroids more than twice a year
Use of more than two cannisters of rescue medication in a year

Choosing Controller Options

Population-Level Decisions

Based on efficacy, effectiveness, safety, availability, and cost at the population level
Considerations include:
- Group mean data for symptoms
- Exacerbations and lung function (from RCTs, pragmatic studies, and observational data)

Individual Patient Decisions

Use shared decision-making with the patient/parent/carer to discuss:
- Preferred treatment for symptom control and risk reduction
- Patient characteristics (phenotype)
- Patient preference
- Medication options, considering factors such as arthritis, patient skills, and cost
Consider using a spacer for ICS by pMDI and avoiding multiple different inhaler types if possible

Inhaler Technique

Check technique at every opportunity
Identify errors with a device-specific checklist
Correct technique with a physical demonstration and re-check up to 2-3 times
Re-check inhaler technique frequently, as errors often recur within 4-6 weeks
Confirm correct technique for prescribed inhalers

Adherence to Asthma Medications

Poor adherence is very common (estimated 50% of adults and children)
Contributes to uncontrolled asthma symptoms and risk of exacerbations and asthma-related death
Contributory factors include:
- Unintentional (e.g. forgetfulness, cost, confusion)
- Intentional (e.g. no perceived need, fear of side-effects, cultural issues, cost)
Identify patients with low adherence by asking empathic questions

Pulmonary Disease Management

Pulmonary disease management is a critical aspect of healthcare, particularly in geriatric populations.

Common Complaints

Cough
Dyspnea
Hemoptysis
URIs
Acute and Chronic Bronchitis
Pneumonia
Single Pulmonary Nodule
Obstructive Sleep Apnea

Cough

Begin with a thorough history
Important factors to consider:
- When did it begin?
- When does it occur?
- What stimulates it/aggravates it?
- What makes it better?
- Describe the quality
- Productive or nonproductive?

Community Acquired Pneumonia (CAP)

Infection of the lung not acquired in the hospital, LTC, or other recent contact with a healthcare system
Evidence of consolidation on CXR
Treatment Guidelines from IDS/ATS
Management of CAP in older adults from TAID

Etiology

Healthy: Strep pneumoniae, Mycoplasma pneumoniae, Chlamydophila pneumoniae, H influenzae, etc.
Elderly nursing home residents: Nosocomial gram negatives
Immunocompromised: CMV or PCP

Pneumococcal Pneumonia Clinical Features

S pneumoniae (gram +)
Abrupt onset
Productive cough—rusty colored sputum
Fever, chills
Pleuritic chest pain
More subtle in older patients—could present with altered mental status or weakness

Atypical Pneumonia Clinical Features

Mycoplasma pneumoniae main organism
Headache, sore throat
Myalgia
Dry hacking cough
Pathogens “atypical” as will not gram stain due to no cell wall
Most common in persons under aged 40

Differences in Presentation

Mycoplasma Pneumonia: Sore throat, fever, dry hacking cough
Complications: Sinusitis, OM, erythema multiforme or erythema nodosum, intravascular hemolysis, meningoencephalitis, toxic psychosis, myocarditis or pericarditis
Persistent hacking cough for up to 6 weeks
Relapse occurs in 10 percent
Chlamydia Pneumonia: Biphasic illness
Younger individuals
Severe pharyngitis and laryngitis
Fever
Cough

Physical Exam

No specific signs can confirm pneumonia
PE cannot reliably distinguish type of pneumonia
Tachypnea—more common in older adults
Pulse oximetry screening should be performed if suspect CAP
Fever
Increased tactile fremitus, dullness to percussion, egophony
Crackles (rales)
Bronchial breath sounds

Diagnostic Testing

CXR required to differentiate
Normal CXR does not exclude diagnosis
Pulse Ox
CBC with diff
Electrolytes
Rapid test for influenza may be helpful
Additional testing is indicated in those severely ill, those immunosuppressed, and those HIV+

CAP Ambulatory Treatment

Hydration
Respiratory hygiene
ASA or acetaminophen for fever & HA
Smoking Cessation
Prevention—pneumococcal & influenza vaccine

CAP—Empiric Treatments

Outpatient: Azithromycin, Clarithromycin, Doxycycline
Inpatient, non-ICU: Levofloxacin, Moxifloxacin, Combination of a beta-lactam + macrolide
Inpatient, ICU: Combination of a beta-lactam + macrolide, Levofloxacin, Moxifloxacin

CURB-65—Mortality Prediction Tool for Patients with CAP

Confusion
Urea >7 mmol/L
Respiratory rate ≥30/min
Blood pressure ≤90 mmHg
Age ≥65 years

Chronic Cough

Lasting beyond 8 weeks
Most common causes: postnasal drip, GERD, Asthma
Differential diagnoses: Cigarette smoking, postnasal drip/allergies/chronic sinusitis, Bronchospasm/asthma, CHF, Bronchogenic/mediastinal tumors, Chronic pulmonary infections, etc.

Bronchiectasis

Chronic cough
Overproduction of secretions
Reduced clearance of secretions
These result in excess airway secretions

Chronic Cough—Evaluation

History: development, duration, character, precipitants
Environmental exposures
Tobacco use
History of asthma or COPD
Swallowing/throat clearing
GI symptoms
Physical Exam: ENT, Lungs, Cardiac, Abdomen
CXR: excludes malignant disease, bronchiectasis, persistent pneumonia, sarcoidosis, TB
Spirometry

Diagnostics

CT chest with contrast
Spiral CT
Barium esophagography
Cardiac evaluation
Bronchoscopy
GI evaluation
Barium swallow and/or 24-hour pH esophageal monitoring
CT sinuses—ENT evaluation

Treatment

Stop offending meds
Treat underlying cause
Consider trial of H2 blockers or PPI
Anti-tussives as indicated
Stop smoking

Single Pulmonary Nodule

Common incidental finding on CT
Review with new algorithms for evaluation and management
Pure subsolid SPN < 5mm require no follow-up
If SPN < 8mm follow Fleischner Society guidelines on intervals for repeat CT
If SPN >8mm refer specialist

Obstructive Sleep Apnea

Pause in breathing for 10–90 seconds
Central apneas: absent airflow and respiratory efforts
Neurological diseases
Obstructive apneas (OSA): Tongue and soft palate fall backward
Mixed apneas

Consequences

Pulmonary HTN
HTN with LV Dysfunction
Cardiac dysrhythmias
Psychomotor defects
Hypoxia and hypercapnia

Management

General measures: Avoidance of alcohol, sedatives, hypnotics
Specific measures: Position therapy, Positive airway pressure (CPAP, bilevel systems, auto-CPAP), Oral appliances, Surgical management

Geriatric Specific Considerations

Age-related pulmonary changes: Reduced airway size, Shallow alveolar sacs, Decline in chest wall compliance, Intercostal muscle atrophy, Reduction in diaphragmatic strength by 25%

Rhinosinusitis

Approaches to diagnosis, treatment do not differ with age
Treat bacterial rhinosinusitis with analgesics, saline irrigation, and antibiotics if symptoms ≥7 days or worsen
Treat chronic rhinosinusitis with topical nasal steroids and saline irrigation
Treat allergic rhinosinusitis by recommending avoidance of inciting allergens and/or with topical nasal steroids and anti-allergy medications

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

Learn about initiating and stepping down asthma treatment, including adjusting medication and finding the minimum effective dose to control symptoms and exacerbations.

Asthma Treatment and Management

Choose a study mode

Podcast

Questions and Answers

What is the primary goal when stepping down asthma controller treatment?

When considering stepping down asthma controller treatment, what should be recorded?

What is recommended for patients with ≥1 exacerbations in the previous year?

According to the guidelines, what should be avoided in patients with severe asthma?

What is the recommended approach to stepping down ICS doses?

What is an important component of guided asthma self-management?

What should be referred to a specialist center, if available, for consideration of add-on medications and/or sputum-guided treatment?

What is recommended for patients with confirmed food allergy?

What is a non-pharmacological intervention for asthma management?

What is discouraged in adults with asthma due to the risk of exacerbations?

What is an essential aspect of the stepwise approach to control asthma symptoms and reduce risk?

What is the primary goal of a step-up therapy in asthma management?

Which of the following is a non-pharmacological strategy for asthma management?

What is an important consideration when developing an asthma action plan?

What is a potential systemic side-effect of inhaled corticosteroids (ICS) in asthma management?

When is a step-down therapy considered in asthma management?

What is the preferred controller choice in the stepwise approach to asthma management?

Which of the following is a factor to consider when adjusting ICS dosing in asthma management?

What is an essential aspect of patient education in the stepwise approach to asthma management?

What is the primary goal of assessing lung function in asthma management?

What is the first step to consider when thinking about stepping up asthma treatment?

In which patients with allergic rhinitis is adding SLIT considered?

What is the recommended approach when symptoms are controlled for 3 months?

What should be advised about non-pharmacological therapies?

What should be treated in asthma management?

What should be checked before stepping up asthma treatment?

If a patient's symptoms are not typical of asthma, what should be done next?

What is the next step if the results of spirometry/PEF with reversibility test support asthma diagnosis?

What is the primary goal of the initial evaluation in asthma diagnosis?

When is a detailed history/examination for asthma warranted?

What is the purpose of further history and tests for alternative diagnoses?

When can a patient's symptoms be considered controlled?

What is the next step if the results of spirometry/PEF with reversibility test do not support asthma diagnosis?

What is the main goal of the initial evaluation in asthma diagnosis?

What is the primary goal when assessing a patient's cough?

Which of the following is a geriatric specific consideration in pulmonary disease management?

What is a common complaint associated with pulmonary disease?

Which of the following is a differential diagnosis for cough?

What is a characteristic of a productive cough?

What is a major player in pulmonary disease management?

What is the primary reason for checking adherence to asthma medications?

What is the estimated percentage of adults and children who do not take controller medications as prescribed?

What is a recommended approach to identify patients with low adherence to asthma medications?

What is a common factor contributing to poor adherence to asthma medications?

What is the recommended approach to improve inhaler technique?

How often should inhaler technique be re-checked?

What is the benefit of brief inhaler technique training?

What should be avoided when prescribing ICS by pMDI?

What is the main difference between atypical pneumonia and pneumococcal pneumonia?

What is the indication for pulse oximetry screening in community-acquired pneumonia (CAP)?

What is the recommended duration of therapy for community-acquired pneumonia (CAP) in severe cases?

What is the most common cause of chronic cough?

What is the definition of chronic bronchitis?

What is the diagnostic test of choice for obstructive sleep apnea (OSA)?

What is a consequence of untreated obstructive sleep apnea (OSA)?

What is the recommended approach to managing chronic cough in geriatric patients?

What is a common misperception about older people with respiratory symptoms?

What is the recommended approach to diagnosing and treating rhinosinusitis in geriatric patients?

What is the frequency of night time symptoms that may indicate the need for an ICS as a controller?

What is the primary consideration when choosing between treatment options at a population level?

In individual patient decisions, what is an important consideration when discussing treatment options?

What is the frequency of cannister use of a rescue medication that may indicate the need for an ICS as a controller?

What is an important consideration when choosing between controller options for an individual patient?

What is the basis for the 'preferred treatment' at each step in the guidelines?

Why is it important to consider the patient's phenotype when choosing between controller options?

What is the primary goal of considering the patient's goals and concerns for their asthma?

What is the estimated percentage of people ≥65 years who meet the criteria for asthma?

What is the primary cause of wheezing in 'cardiac asthma'?

What is the median survival time for patients with idiopathic pulmonary fibrosis?

What is the recommended approach for treating sleep apnea?

What is the leading cause of death in older adults with COPD?

What is the primary benefit of smoking cessation in older adults with COPD?

What is the estimated number of people affected by asthma worldwide?

What is a common complication of obstructive sleep apnea?

What is the primary goal of asthma management in older adults?

What is a characteristic of idiopathic pulmonary fibrosis?