asthma PT

* yes
* post-bronchodilator FEV1 increased by ≥ 12% (consistent with reversibility)
* symptoms: SOB, nighttime awakening, onset in childhood

KC is an 8-year-old female who reports shortness of breath 3 times/week, nighttime awakening 2 times/month, and reports some limitation in activity. Her post-albuterol \n FEV1 is 90% of predicted and improved 25% from pre-bronchodilator FEV1. She is diagnosed with asthma by her pediatrician and referred to you to manage pharmacologic treatment

Does her spirometry seem consistent with asthma? WHY?

step 2: SOB 3 times/week, nighttime awakening 2 times per MONTH

KC is an 8-year-old female who reports shortness of breath 3 times/week, nighttime awakening 2 times/month, and reports some limitation in activity. Her post-albuterol \n FEV1 is 90% of predicted and improved 25% from pre-bronchodilator FEV1. She is diagnosed with asthma by her pediatrician and referred to you to manage pharmacologic treatment

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What step of therapy would you start with for KC?

low dose ICS (Flovent, Asmanex, Alvesco, Annuity, Pulmicort, Qvar)

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SABA as rescue inhaler (albuterol)

KC is an 8-year-old female who reports shortness of breath 3 times/week, nighttime awakening 2 times/month, and reports some limitation in activity. Her post-albuterol \n FEV1 is 90% of predicted and improved 25% from pre-bronchodilator FEV1. She is diagnosed with asthma by her pediatrician and referred to you to manage pharmacologic treatment

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What treatment would you recommend?

partially controlled because she still needs to use her inhaler 3 times a week (question = at least 2 times weekly)

KC is an 8-year-old female who reports shortness of breath 3 times/week, nighttime awakening 2 times/month, and reports some limitation in activity. Her post-albuterol \\n FEV1 is 90% of predicted and improved 25% from pre-bronchodilator FEV1. She is diagnosed with asthma by her pediatrician and referred to you to manage pharmacologic treatment

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At her follow up 4 weeks later, she reports experiencing symptoms and needing to use her reliever inhaler 3 days/week ~~still~~, but she did not have any nighttime awakening or limitations in activity from her asthma.

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Based on this, is KC well-controlled, partially controlled, or uncontrolled and WHY?

* patient is partially controlled
* step up 1 step
* **low dose ICS + LABA** or **medium dose ICS** or **very low dose formoterol/ICS MART**

KC is an 8-year-old female who reports shortness of breath 3 times/week, nighttime awakening 2 times/month, and reports some limitation in activity. Her post-albuterol \\n FEV1 is 90% of predicted and improved 25% from pre-bronchodilator FEV1. She is diagnosed with asthma by her pediatrician and referred to you to manage pharmacologic treatment

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At her follow up 4 weeks later, she reports experiencing symptoms and needing to use her reliever inhaler 3 days/week still, but she did not have any nighttime awakening or limitations in activity from her asthma.

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What would you recommend?

* ICS/formoterol PRN (dulera or Symbicort) -- preferred
* ICS when SABA is used -- non-preferred

LG is a 34 year-old female, newly diagnosed with asthma and has symptoms < 2 times per month

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What pharmacologic therapy do you recommend?

severe:

* not able to complete sentences
* some relief from SABA, but not full relief
* severely reduced PEF (38%)

WB is a 18-year-old male who has moderate asthma and was previously well controlled on his low dose Breo Ellipta (fluticasone/vilanterol). He has been feeling well until yesterday, when he started developing signs of a respiratory virus. This morning, he was not able to complete sentences due to his shortness of breath. His albuterol has been helping somewhat, but he does not get full relief. The reading on his peak flow meter indicated he was at 38% of his personal best, at which time he followed the instructions on his asthma action plan and went to the ED.

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How would you classify the severity of the exacerbation?

* increase SABA dose
* start ipratropium if in ED only (discontinues when arrives on floor in house)
* start prednisone 40-50mg QD for 5-7 days
* high dose ICS
* oxygen if oxygen sat is low

WB is a 18-year-old male who has moderate asthma and was previously well controlled on his low dose Breo Ellipta (fluticasone/vilanterol). He has been feeling well until yesterday, when he started developing signs of a respiratory virus. This morning, he was not able to complete sentences due to his shortness of breath. His albuterol has been helping somewhat, but he does not get full relief. The reading on his peak flow meter indicated he was at 38% of his personal best, at which time he followed the instructions on his asthma action plan and went to the ED.

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what therapy would you recommend in the acute setting?

* step up ICS for 2-4 weeks (medium dose Breo Ellipta)
* Change SABA back to PRN
* follow up 2-7 days after discharge

WB is a 18-year-old male who has moderate asthma and was previously well controlled on his **low dose Breo Ellipta** (fluticasone/vilanterol). He has been feeling well until yesterday, when he started developing signs of a respiratory virus. This morning, he was not able to complete sentences due to his shortness of breath. His albuterol has been helping somewhat, but he does not get full relief. The reading on his peak flow meter indicated he was at 38% of his personal best, at which time he followed the instructions on his asthma action plan and went to the ED.

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After his acute exacerbation resolves, what do you recommend?