what are controller medications
- taken daily on a long-term basis
- ics: primary controller
- long acting inhaled beta 2 agonists (laba)
- laba + ics
examples of laba + ics
fluticasone + salmeterol
budesonide + formoterol
fluticasone + formoterol
fluticaonse + vilanterol
what are reliever medications
- as needed basis
- rapid acting inhaled b2 agonists (saba), sama, methylxanthine
what is smart therapy
- single inhaler maintenance and relief therapy
- formoterol and budesonide for rescue and maintenance
- reduced exacerbations
- improvements in asthma control
criteria for diagnosing asthma
- variability: episodic, precipitation by allergens, nocturnal worsening of symptoms
- response to appropriate asthma therapy
- family history
levels of asthma control
- controlled
- partly controlled
- uncontrolled
factors: daytime symptoms, limitations in activities, nocturnal symptoms, need for rescue treatment, lung function, exacerbation
gina guidelines for initial control
<2x/mo = as needed low dose ics-formoterol
> 2x/mo = daily low dose ics or as needed low dose ics-formoterol
most days, waking 1x/wk = low dose ics-laba
most days, waking >1x/wk = medium dose ics-laba
more symptomatic and uncontrolled than step 4 = high dose ics-laba
gina initiative for asthma
- assess: diagnosis, risk factors, comorbids, technique and adherence!!, preferences and goals
- adjust
- review response
preferred reliever for steps 1-5
low dose ics-formoterol, as needed
gina no longer recommends ____ treatment for step 1
saba-only: increases risk for severe exacerbations
t/f episodes of high reliever use (>6 inhalations/day on at least one day) dont predict mortality and risk for exacerbations
false!! they predict these outcomes
what is mild asthma
- symptoms of less than weekly for the previous 3 months
what is an exacervation
progressive worsening of shortness of breath, cough, wheezing, or chest tightness, or a combination
_____ are better indicators for severity of airflow obstruction than degree of symptoms
significant decreases in pef or fev1
therapies for exacerbations
- repetitive rapid acting inhaled b2 agonist (saba)
- early systemic glucocorticoids (hydrocortisone, prednisone)
- o2 supp
commonly used glucocorticoids
- dexamethasone (iv and oral)
- hydrocortisone (iv)
- methylprednisolone
- prednisone
