NR566_ Week 2 CHAPTER 30: Asthma and COPD complete study guide

Diagnosis Classification of Asthma:  Adults and >12 yo: o Mild intermittent asthma  s/sx occur less often twice a week  pt is asymptomatic in b/w exacerbation  nighttime symptoms: <2x a month  PEF: >80% predicted  SABA use: < 2x a week o Mild persistent asthma  s/sx occur more often than twice a week, but less often than once a day  exacerbation may affect activity  nighttime symptoms: 3-4x a month  PEF: >80% predcited  SABA use: >2x a week (but not daily, not >once a day) o Moderate persistent asthma  s/sx: daily  exacerbation affects normal activity  nighttime symptoms: >once a week  PEF: >60% and <80%  SABA use: daily o Severe persistent asthma  s/sx: some degree of s/sx ALL THE TIME.  Extremely limited physical activity with frequent exacerbations  Nighttime symptoms: often 7x a week  PEF: decreased, <60% predicted  Children o Mild intermittent asthma  s/sx occur less often than twice a week  pt is asymptomatic in b/w exacerbation  nighttime symptoms: • 0-4 yo: none • 5-11 yo: <2x a month  PEF: >80% predicted  SABA use: < 2x a week  Corticosteroids use: no more than once a year o Mild persistent asthma  s/sx occur more often than twice a week, but less often than once a day  exacerbations may affect activity • <4 yo: >2x in 6months requiring systemic steroids or 4 episodes of wheezing in a year lasting more than a day and risk factors for persistent asthma. • 5-11 yo: 2 or more exacerbations a year  nighttime symptoms: • 0-4 yo: 1-2x a month • 5-11 yo: 2-4x a month  PEF: >80% predicted  SABA use: > 2x a week o Moderate persistent asthma  s/sx: daily  exacerbations: 2 or more per year  nighttime symptoms: • <4 yo: 3-4x a month • 5-11 yo: > 1x a week, but not nightly  SABA use: daily  PEF: >60% and <80% o Severe persistent asthma  s/sx: some degree of s/sx ALL THE TIME.  Extremely limited physical activity  Exacerbations: 2 or more a year (5-11 yo)  Nighttime symptoms: frequent • <4 yo: > 1x a week • 5-11 yo: 7x a week  PEF: <60% predicted Risk Factors for Fatal Asthma Attacks  HOME MANAGEMENT OF ASTHMA EXACERBATIONS IS AN INTERGRAL PART OF ASTHMA MANAGEMENT  Patients need to be educated to recognize early symptoms of decreasing lung function and to adjust their medications accordingly  Fatal Risk Factors: o Previous severe exacerbations requiring intubation or ICU admission d/t asthma o 2 or more hospitalizations or >3 ER visits in a year d/t asthma o Use of >3 canisters of SABA in a month o Difficulty perceiving airway obstruction or worsening asthma o Low socioeconomic status or inner-city residence Asthma Step Therapy and Goals of Therapy  Goals: o Reduce impairment:  Prevent chronic and troublesome s/sx (e.g. coughing or breathlessness at night, early morning, or after exertion)  Require infrequent use (<2x a week) for inhaled SABA for relief of symptoms (not including use of EIB)  Maintain (near) “normal” pulmonary function  Maintain (near) normal activity levels  Meet patients’ and families’ expectations of and satisfaction with asthma care. o Reduce risk:  Prevent recurrent exacerbation of asthma and minimize the need for ER visits or hospitalizations  Prevent loss of lung function; for children, precent reduced lung growth  Provide optimal pharmacotherapy with minimal or no adverse effects