You are on page 1of 19

RESPTrec

National Certification
Examination
Asthma Study Session
October, 2009
RESPTrec

Review of Asthma Content
Definition
Provoking Factors
Diagnosis & Evaluation
Control & Severity
Asthma Management Continuum
Therapy
Self-management
RESPTrec

Definition
Chronic inflammatory disease characterized by:
Recurrent (paroxysmal) or persistent symptoms -
one or a combination of cough, wheeze, chest
tightness, sputum production and dyspnea
Variable airflow limitation
Airway hyperresponsiveness
To endogenous & exogenous stimuli
RESPTrec

Provoking Factors
Inflammatory Triggers

Symptom Triggers
RESPTrec

Diagnosis
Preschool children
School-age children & adults

PEF
Spirometry
Airway hyperresponsiveness
RESPTrec

Evaluation
PEF
Spirometry
Airway hyperresponsiveness
RESPTrec

Control
Parameter Frequency
1. Daytime symptoms < 4 days/week
2. Night-time symptoms < 1 night/week
3. Physical activity Normal
4. Exacerbations Mild, infrequent
5.Absenteeism from
work or school
None
6.Need for prn short-
acting
2
-agonist
< 4 doses/week*
7. FEV
1
or PEF 90% or greater personal best
8. PEF diurnal variation**
<10-15% diurnal variation (during 14 day
period)
RESPTrec

Severity
(Level of treatment needed to maintain control)
Asthma Severity Symptoms Treatment Required
Very Mild Mild infrequent
None, or inhaled 2-agonist
rarely
Mild Well-controlled
2-agonist (occasionally) + low-
dose inhaled glucocorticosteroid

Moderate Well-controlled
2-agonist (occasionally) + low
to moderate doses inhaled
glucocorticosteroid +/-
additional therapy
Severe Well-controlled
2-agonist + high doses inhaled
glucocorticosteroid + additional
therapy
Very Severe May be controlled or not well-
controlled
2-agonist + high doses inhaled
glucocorticosteroid + additional
therapy + oral
glucocorticosteroid
RESPTrec

Proposed Dose Equivalencies For
Inhaled Glucocorticosteroids
PRODUCT Brand Name LOW DOSE MEDIUM DOSE HIGH
DOSE
Beclomethasone dipropionate pMDI +
spacer (REFERENCE)
No longer
available
<500 g 501 to 1000 g >1000 g
Budesonide Turbuhaler Pulmicort
< 400 g 401 to 800 g > 800 g
Fluticasone Dipropionate pMDI +
spacer
Flovent
< 250 g 251 to 500 g > 500 g
Fluticasone Dipropionate Diskus Flovent
< 250 g 251 to 500 g

>500 g
Beclomethasone dipropionate pMDI
(HFA)
QVar
< 250 g 251 to 500 g >500 g
Ciclesonide pMDI Alvesco
< 160 g 161 to 320 g >320 g
Budesonide wet nebulization Pulmicort
< 1000 g 1001 to 2000 g >2000 g
RESPTrec

Very mild Mild Moderate Moderately
Severe
Severe
Environmental Control
Education, Written action plan, and Follow-up
Fast-acting bronchodilator on demand

Low Moderate High
Inhaled Corticosteroids
Add-on therapy
Pred
CONTINUUM of Adult Asthma Management
Regularly assess:
Control
Triggers
Compliance
Inhaler Technique
Co-morbidity
RESPTrec

Therapy
Education
Environmental Control
Pharmacotherapy

Other:
Immunotherapy
Unconventional

RESPTrec

Reduce or eliminate exposure to triggers
Environmental Control
Primary
Families with bi-parental atopy to avoid cats or dogs
Breastfeeding should be recommended
Secondary
Avoid tobacco smoke
Appropriate environmental control for house dust
mites sensitivity
Tertiary
Eliminate or avoid exposure to known allergens
RESPTrec

Pharmacotherapy
Type of medication
Function of medication
Generic & brand names of the medications
Side effects
Recommendations
Fast-Acting Beta-2 Agonists
Inhaled Glucocorticosteroids
Long Acting Beta-2 Agonists
Leukotriene Receptor Antagonists
Oral Theophylline
Oral Glucocorticosteroids
Anticholinergics
Anti-IgE
RESPTrec

Self-management
Diary form

Action plan
RESPTrec

Sheilas name appears for the second time in two weeks in
the appointment book. Her asthma has been causing trouble
lately: she experiences almost daily symptoms, her sleep is
disturbed because of asthma three times a week, and she is
not able to attend her regular exercise classes. Shes been
prescribed daily ICS for six months and uses Ventolin for
breakthrough wheezing, chest tightness and breathlessness.

Key issues
Actions to take for each issue
Asthma Case Scenarios
RESPTrec

Marty and Sara have a four year old female with asthma
and allergies, one of which causes an anaphylactic reaction
to peanuts. The first time that their child was exposed to
peanuts (that they know of), Sara had to rush her in to
emergency because of a severe difficulty in breathing,
swollen mouth, red itchy skin and flushed face. Marty
arrived at the emergency department in time to help take
their daughter home. Marty refuses to ensure there is an
epipen available when he is providing child care because
he does not believe that their daughter had an anaphylactic
reaction; he feels that Sara overreacted.

Key issues
Actions to take for each issue
Asthma Case Scenarios
RESPTrec

Peter is in his first year at University. He was diagnosed
with asthma as a child and has controlled it with use of
daily ICS and as needed rescue medications. At a recent
party where there was cigarette smoke in the environment,
he became extremely short of breath and started coughing.
After a couple of puffs of his rescue medication, he felt
much better and was able to stay at the party an additional
three hours. Later at home, he collapsed while taking a
shower. His mother heard him fall, and he was rushed to
the local hospital. Upon discharge, the hospital staff
recommended he see an asthma educator.

Key issues
Actions to take for each issue
Asthma Case Scenarios
RESPTrec

Mary is a 67 year old widow who shares her apartment
with two cats. She has had asthma since childhood and is
currently taking Symbicort daily. However, she is
experiencing a persistent daily cough and wakes up at night
because of her cough.


Key issues
Actions to take for each issue
Asthma Case Scenarios
RESPTrec

?Questions?
Please forward questions to
info@resptrec.org by no later than Friday,
Oct 23
rd

Both the questions and answers will be
posted on the web site (www.resptrec.org) in
the Certification section by October 28
th