Exacerbations

Question 1

Asthma Exacerbation Management (3)

Answer 1

• reliever/rescue therapy
• oral corticosteroids
• oxygen supplementation

Question 2

Asthma Action Plan

Answer 2

green: breathing is good, no coughing or wheezing, sleep through night, can work & play
yellow: first signs of cold, exposure to known trigger, cough, mild wheezing, tight chest, coughing at night
red: medicine not helping, breathing is hard, nose opens wide, trouble speaking, ribs show in children

Question 3

What is the glucocorticoid preferred medication for a pt with Asthma and dosing for exacerbations for a pt who has:
- Sx not responding to increase in reliever
- rapid clinical deterioration or PEF/FEV1 <60% predicted or best
- worsening asthma in someone with h/o sudden severe exacerbations

Answer 3

Prednisone/Prednisolone: 40-50 mg po qd 5-7d

Question 4

What is the glucocorticoid preferred medication who has COPD and dosing for exacerbations?

Answer 4

Prednisone:40 mg po qd 5d
-↑ duration may be associated with ↑ risk of pneumonia and
mortality
- Improves: lung function, oxygenation/Reduces: recovery time, length of hospitalizations

Question 5

What is an exacerbation

Answer 5

-increase in symptonms compared to baseline
-decrease in lung function
-impact on disease state outcomes

Question 6

Reliever/Rescue therapy Asthma

Answer 6

Rescue therapy will be dependent on what reliever the patient is prescribed (i.e., ICS/formoterol, ICS/SABA, or SABA)
* Dosing: differs from usual reliever instructions, often an increase in number of puffs and frequency
-Acute exacerbation: 2-4 inhalations Q20 minutes X3 doses
-Intermittent symptom relief: 1-2 inhalations Q4-6 hours PRN

Question 7

When considering glucocorticoids, think

Answer 7

Life-saving treatment, but risk/benefit should be evaluated

Question 8

COPD Exacerbation management

Answer 8

Bronchodilators, glucocorticoids, antibiotics

Question 9

Antibiotics in COPD

Answer 9

Infection is leading cause of COPD exacerbation
-Initiate in timely fashion, first 2 days most effective
- Evidence supports initiation of antibiotics in patients who have at least TWO of the following symptoms:
* Increase in dyspnea, Fever, Increase in sputum volume, **Sputum purulence