bridgetmclendon

Assessment of the Child with Chronic Asthma Are there other allergic disorders? - Allergic rhinitis - Eczema, etc. Other causes should be sought if there is: - Sputum - Finger clubbing - Growth failure Monitor: - Peak flow diary - Severity and frequency of symptoms - Exercise tolerance - Interference with life, time off school - Is sleep disturbed? - Use of preventer and reliever medication — are they appropriate? - Inhaler technique Consider triggers: - Allergic rhinitis needing treatment? - Allergens - animal dander, etc. - Stress #Chronic #Asthma #Assessment #diagnosis #peds #pediatrics #primarycare

Consensus diagnostic criteria for asthma-COPD overlap syndrome (ACOS) in patients with airflow limitation. COPD=chronic obstructive pulmonary disease; CT=computed tomography; FeNO=fractional exhaled nitric oxide; FEV1=forced expiratory volume in 1 s; FVC=forced vital capacity; LLN=lower limit of normal #Diagnosis #PCC #IM #ACOS #AsthmaCOPD #OverlapSyndrome #Asthma #COPD #Criteria #BMJ

An Integrated Multidisciplinary Approach to Assessment and Initial Management of Difficult-to-Treat and Severe Asthma in Adults. MART (maintenance and quick-relief therapy) involves a low-dose inhaled glucocorticoid and formoterol as the patient’s regular therapy and as quick-relief therapy. This regimen reduces exacerbations and allows the use of lower doses of inhaled glucocorticoids #Management #PCC #Asthma #Severe #Algorithm #Multidisciplinary #DifficultToTreat #Assessment #NEJM

Assessment and Treatment of Severe Asthma, According to Inflammatory Phenotypes, in Patients without a Response to Core Multidisciplinary Management. Eligibility for omalizumab includes an IgE level of at least 30 IU per milliliter and evidence of reactivity to at least one perennial aeroallergen. #Management #PCC #Asthma #Severe #Algorithm #Phenotypes #NEJM

Stepwise approach for managing asthma in youths greater than 12 years of age and adults as recommended by the Expert Panel 3 of the National Asthma Education and Prevention Program(4) Therapy should be increased to the next step if symptoms are not well controlled or poorly controlled, as indicated by the use of short-acting β2-agonists or the presence of asthma symptoms more than 2 days per week, nighttime awakenings due to asthma symptoms at least once per week, some interference with normal activities, or a reduction in FEV1 or peak flow below 80% of predicted or personal best. Allergen immunotherapy may be considered for patients at steps 2 – 4, especially those with single allergies to house-dust mites, animal danders or pollens. Health care providers should be prepared to identify and treat anaphylaxis that can be associated with immunotherapy and omalizumab. All patients should receive education, environmental control and management of co-morbidities. If asthma is well controlled for at least 3 months, then therapy should be decreased downward to the next step. Abbreviations are as follows: ICS (inhaled corticosteroids), LABA (long-acting β2-agonists), LTRA (leukotriene receptor antagonists), and SABA (short-acting β2-agonists). Ann Intern Med. 2010 Feb 16;152(4):232-7 #Management #Asthma #Stepup #Therapy #LABA #ICS #Corticosteroid

Severe Asthma Algorithm - Management of Life-Threatening Asthma in the Emergency Department Step One 1. Nebulized Albuterol 2. Nebulized ipratropium bromide 3. Methylprednisolone 125 mg IV 4. Magnesium sulfate 2 g IV 5. Nebulized epinephrine Step Two 1. Epinephrine 0.5 mg IM 2. Fluid bolus 20 cc/kg 3. Diagnostics: Chest X-ray. CBC, chemistry, verous blood gas. HCG, ECG if concern for non-sinus rhythm or cardiac ischemia Dr. Reuben Strayer @emupdates #Emergency #Management #CriticalCare #Severe #Asthma #Exacerbation #Algorithm

Asthma Severity Classification and Step Therapy #Diagnosis #Management #Asthma #Classification #Severity #Step #Therapy #ALiEM

First-line therapies for Asthma, Asthma-COPD Overlap and COPD The diagnosis of COPD, asthma, and ACO initially requires an evaluation of exposure to respiratory risk factors, identification of the type and pattern of respiratory symptoms, and spirometry with a bronchodilator test. If required, specific tests, such as blood analysis with eosinophil counts and IgE levels, bronchoprovocation test, and sensitivity tests for pneumoallergens, can be used. A summary of the differential diagnosis and first-line therapies is depicted. ACO = asthma-COPD overlap; ICS = inhaled corticosteroids; LABA = long-acting β2-agonist; LAMA = long-acting muscarinic antagonist. #Diagnosis #Management #ACOPD #Asthma #Overlap #FirstLine #Differences #Algorithm #Treatment

Algorithm for Management of Acute Exacerbation of Asthma in Adults in the Emergency Department #Asthma #Exacerbation #Algorithm #Management #Pulmonary

Asthma: immunopathogenesis. Allergens attach to, and are taken up by, dendritic cells that he the respiratory epithelium. The interaction of the allergen (antigen), antigen presenting cells, and native T cens leads to the differentiation of the T cells to T-helper (TH2) cells, which release cytokines. IL-4 activates B cells. which differentiate into plasma cells and release IgE that attaches to the surface of mast cells. The mast cells then degranulate when the allergens bridge two IgE molecules on their surface, especially when they are activated by IL-3. This cascade of events releases inflammatory mediators that are responsible for the mucosal swelling, and increased mucus production allergic asthma. (ECP, cationic protein; NBP, major basic protein; PAF, platelet-activating factor.) #Asthma #immunopathogenesis #Pathophysiology #Pulmonary