Asthma

Asthma

• Path:
  • 1. chronic airway inflammation
    
  • 2. mucus hypersecretion
    
  • 3. intermittent and reversible airway obstruction from smooth muscle contraction (physical obstruction of bronchiole)
    
  • 4. bronchial hyperresponsiveness (more responsive to triggers, allergins, smoke)

• ---

  Triggers:
  • URI
    
  • exercise
    
  • weather (cold)
    
  • stress
    
  • irritant exposures (smoke, pet, mold)
    
  • meds (BB, ASA, NSAIDs)

• ---

  Classification:
  • intermittent – symptoms < 2/wk; @night <2/mo, asymptomatic and normal PEF blw excerbations
  • mild persistent – symptoms > 2/wk, but < 1/day; @ night > 2/mo
  • mod persistent – need daily SABA; @night >1/wk, acute exacerbation > 2/wk
  • severe persistent – continual symptoms that limit physical activity; @ night – frequent

• ---

  Dx:
  • Spirometry:
    • FEV1 < 70%
      
    • FEV1/FVC normal or decreased relative to predicted values (70-85%) (usually decreased)
      
    • reversibility of 12% or more (8% or more in young kids) in FEV1 with bronchodilator

• ---

  Treatment:
  • Step 1 – intermittent: select SABA PRN
    
    • Albuterol, ( Provent, ProAir )
    • Levalbuterol (Xopenex) or Pirbuterol (Maxamir)
  • Step 2 – mild persistent: SABA PRN + low dose inhaled corticosteroid
    • fluticasone, budesonide (Pulmicort)
      
    • Ciclesonide (MDI (ALVESCO)
      
    • Beclomethasone dipropionate
  • Step 3 – moderate-persistent: SABA PRN + Med dose inhaled corticosteroid + LABA 
    
    • Salmeterol, Formoterol, or Arformoterol
    • Fluticasone/ Salmeterol: Advair
      
    • Budesonide/ Formoterol: Symbicort
  • Step 4 – Severe persistent: SABA PRN + High dose inhaled corticosteroid + LABA
    • Salmeterol, Formoterol, or Arformoterol
    • Fluticasone/ Salmeterol: Advair
      
    • Budesonide/ Formoterol: Symbicort