What are the classifications of asthma?
- intermittent
- mild persistent
- moderate persistent
- severe persistent
- symptoms less than 2 days/week
- nighttime awakening less than 2X’s/month
- meds such as albuterol less than 2 days a week
- no interference with normal activity
- normal FEV between exacerbations
- exacerbations requiring corticosteroids 0-1/year
intermittent asthma
- symptoms greater than 2 days/week but not daily
- nighttime awakening 2-4x/month
- meds such as albuterol greater than 2 days a week, but not daily
- interference with normal activity minor limitation
- FEV greater than 80%
- exacerbations requiring corticosteroids greater than 2xs per year
mild persistent asthma
- symptoms daily
- nighttime awakening 3-4x/month, 1x/per week but not nightly
- meds such as albuterol daily
- interference with normal activity some limitation
- FEV 60-80%
- exacerbations requiring corticosteroids greater than 2xs per year, more frequent and intense events indicate greater severity
moderate persistent asthma
- symptoms daily
- nighttime awakening nightly
- meds such as albuterol daily
- interference with normal activity extreme limitation
- FEV less than 60%
- exacerbations requiring corticosteroids greater than 2xs per year, more frequent and intense events indicate greater severity
severe persistent asthma
What are the asthma rescue medications?
- short acting Beta2 agonists: albuterol (Proventil) give before inhaled steroid
- corticosteroid: Methylprednisolone (solu-medrol, prednisone)
- anticholinergic: Ipratropium (atrovent)
What are the asthma controller medications?
- long acting Beta2 agonists: Salmeterol (serevant) used in combo with inhaled corticosteroids
- corticosteroids: beclomethasone (Qvar)
- mast cell inhibitors: cromolyn sodium (intal)
- leukotriene modifiers: montelukast (singulair)
- Methylxanthines: Theophyline
What does the FDA require there be a warning for with corticosteroids?
reduced rate of growth
What do beta agonists do?
relax smooth muscle in airway to increase air exchange to obtain clear breath sounds
What do corticosteroids do?
Diminish airway inflammation and obstruction. Enhance bronchodilation effect of beta agonists.
What are some asthma home control measures?
- avoid triggers
- annual influenza vaccine
- treat rhinitis, sinusitis, GERD
- proper use of medications
- home monitoring
- action plan
- care at school
-respiratory distress continues despite vigorous therapeutic measures
-emergency treatment is epinephrine 0.01 ml/kg subcutaneously (max dose 0.3ml)
-concurrent infection in some cases
-therapeutic intervention:
humidified oxygen
inhaled aerosolized short acting beta agonists
systemic corticosteroid
IV infusion fluids may include magnesium sulfate
status asthmaticus
