# *** (Mild Intermittent, Mild/Moderate/Severe Persistent) Asthma
DDx: *** vocal cord dysfunction, ABPA, EGPA, occupational asthma, ASA-exacerbated (polyps)
-- Maintenance: *** go up ladder if >2 in either rescue inhaler use per week or nighttime awakenings per month; go down ladder if well controlled for 3 months; adjusting q6-8 weeks; ICS-LABA options - budesonide-formoterol (Symbicort), fluticasone-salmeterol (Advair), fluticasone-vilanterol (Breo Ellipta)
-- Exercise-Induced: *** PRN albuterol or ICS-LABA 15 mins prior to exercise, add montelukast daily if needed
-- Action Plan: *** by PEF or symptoms; albuterol rescue inhaler vs 4x controller ICS PRN → pred 40mg for 5 days → hospital
-- Exacerbations: ***
Template coming soon!
Instructions for Using Different Inhalers and Sprays
ICS - take right before brushing teeth to avoid thrush
Nasal Spray - prime, point to lateral eye, use contralateral hand, head tilted down, use ipsilateral hand to open nostril on lateral side, don't sniff aggressively instead do a few snall sniffs
Metered Dose Inhaler (MDI) - shake inhaler, prime (if haven't used recently), breath out, squeeze, slow and deep breath, hold for 5-10 seconds at max inhalation; only do one puff at a time; spacer will whistle if you go too fast
Dry Powder Inhaler (Diskus like Advair or Spiriva) - all different but in general, click to release powder, then very quick, deep breath
Asthma is by definition a disease with intermittent obstruction so they should not be chronically short of breath if they only hold a diagnosis of asthma and are controlled. Newer guidelines recommend starting with ICS-LABA (Symbicort, Advair, Breo Ellipta) PRN rather than using albuterol PRN. Go step-wise unless the patient is very poorly controlled, in which case you can jump up steps and then work your way back every 6-8 weeks. FEV1/FVC ratio may be normal in asthma, depending on whether the patient is in the midst of an exacerbation or not. Ask about how often the patient is using their rescue inhaler each week, and how often they have nighttime awakenings per month. If the answer is more than 2 for either, their asthma is poorly controlled and you need to go up a step. Make sure patients are using their inhalers correctly! Ask them to show you!