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Asthma Review 2014 Power Point FINAL PDF

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Asthma in a Nutshell
Holger Link, MD
The Complexity of Asthma
Immune
System
Genes Environment
Injury and
Repair
Predicting asthma in young frequent “wheezers”
Children less than 3 years of age with >3 episodes of wheezing per
year and at least 1 major or 2 minor criteria:
 Major Criteria:
- Parental asthma
- Eczema
 Minor Criteria:
- Allergic rhinitis
- Wheezing apart from colds
- Eosinophilia >4%
Am J Respir Crit Care Med Vol. 2000; 162: 1403-1406
Initial asthma visit
Establish Diagnosis
Determine Severity
Identify triggers
Start Medication
Educate:
Treatment goals
Inhaler technique
Elimination of triggers
Asthma action plan
Explore parent's and
patient's perspective
Review and implement short
and long term follow up
schedule
Adapted with modification from the National Asthma Education and Prevention Program.
Asthma Care Quick Reference Guide: Diagnosing and Managing Asthma, 2012. NIH
Publication No. 12-5075. Bethesda, MD: National Heart, Lung, and Blood Institute.
Follow up asthma visit
Assess Asthma Control
Review asthma action
plan, treatment goals,
proper inhaler use and
parent/patient concerns
Parents and patient
monitor asthma
symptoms
Identify asthma triggers
and plan for elimination
Schedule follow up visit
Adjust medication if
needed according to six
step model
Adapted with modification from the National Asthma Education and Prevention
Program. Asthma Care Quick Reference Guide: Diagnosing and Managing Asthma, 2012.
NIH Publication No. 12-5075. Bethesda, MD: National Heart, Lung, and Blood Institute.
Goals of asthma therapy
 Impairment:
−
−
−
−
Good quality of life
Good symptom control
Rare use of b2-agonist
No exercise or activity limitation
 Risk:
̶
̶
̶
Decrease emergency department visits or hospital
admissions
Decrease number and severity of exacerbations
Reduce medication side effects
Troubleshooting poorly controlled asthma
 Confirm that patient takes medication
 Review correct inhaler technique
 Try different medication combinations
 Identify and removed all triggers
 Consider alternative diagnosis
Alternative diagnoses
Red Flag
Possible Diagnosis
Sudden onset of symptoms
Foreign body
Coughing and choking when eating or drinking
Oropharyngeal dysphagia with aspiration
Poor growth and low body mass index
Cystic fibrosis, immune deficiency
Family history of sterile males
Cystic fibrosis, immotile cilia syndrome
Chronic rhinorrhea and recurrent sinus infections
Cystic Fibrosis, immotile cilia syndrome
Acute onset without prior history of asthma in teenager
Vocal cord dysfunction
Chronic wet productive cough
Bronchiectasis
More than two episodes of pneumonia
Immune deficiency
Red flags for vocal cord dysfunction
 Not responding to standard asthma therapy
 Very acute onset and resolution of Sx
 Onset of symptoms in teenage years
 Never symptomatic during sleep
 Negative family history
 Negative allergic history
Normal and abnormal flow-volume loop
Normal flow-volume loop
Inspiratory flow-volume loop limitation
as seen in vocal cord dysfunction
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