Asthma

Key Points ÎAsthma is a chronic inflammatory disorder of the airways characterized by paroxysmal or persistent symptoms, such as shortness of breath, wheezing, cough, sputum production, and chest tightness, accompanied by variable airway hyper-responsiveness and degrees of airway obstruction. Asthma suspected? ÎDetermine presence of: > Airway hyper-responsiveness > Episodic symptoms of (at least partially reversible) airflow obstruction ÎDetailed medical history ÎPhysical exam focusing on upper respiratory tract, chest, skin ÎConfirm asthma by spirometry: > Improvement in obstructed FEV1 YES Acute asthma exacerbation? (Figure 1) 5 minutes after using inhaled short-acting β2 > An increase > 10% of predicted FEV1 Chronic asthma management? (Table 3) ÎSeverity of asthma should be determined by: > Lung function and frequency and duration of symptoms (including nocturnal). > Classification (mild intermittent to persistent categories) to determine treatment. > If asthma is well controlled, severity may be judged by determining minimal treatment needed to maintain acceptable control. ÎBest treatment strategy is to keep TABS on asthma, with emphasis on: > Trigger awareness, avoidance, control (Table 8) with focus on altering patient behavior, not just providing information. > Action plan in writing for patient self-management based on evaluation of symptoms or Peak Expiratory Flow Rate (PEFR). > Best symptoms/function level determined through patient self-monitoring PEFR diary linked to written action plan. > Steroids for maintenance therapy, proper use of spacer/holding chamber device. > Other controllers are long-acting β2 -agonists (LABA†), leukotriene-receptor antagonists (LTRA), anti-allergic or inhaled nonsteroidal agents, and theophyllines taken regularly to control symptoms and prevent exacerbations. ÎBenefits of inhaled steroids for children substantially outweigh risks. ÎEach new treatment should be considered a therapeutic trial, with efficacy assessed by monitoring symptom control and lung function. †BLACK BOX WARNING: Long-acting β2 -adrenergic agonists may increase the risk of asthma-related death. They should never be used alone in children or adults with asthma. Please see product labeling for information on this warning. An FDA Medication Guide should be distributed to patients starting a new prescription. by ≥ 12% from baseline and 200 mL at -agonist, or after inhalation of short-acting bronchodilator NO Consider evaluation for vocal cord dysfunction or other airway abnormalities

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