Asthma

Chronic inflammation of the small airways

Symptoms of recurrent episodes of airflow obstruction or airway hyper-responsiveness

Defined as having REVERSIBLE airway obstruction

NHLBI EPR-3 Guidelines

Do the patient's cold 'go to the chest' or take > 10 days to resolve?

Does the pt. take any medication? Is there relief when symptoms occur? (bronchodilator)

Causal factors: Indoor allergens (domestic animals, cockroach allergens, fungi/molds) Outdoor allergens (pollens, fungi, RSV) Occupational exposure

Host Factors: genetic atopy (increased IgE, AWHR)

Contributing factors: resp. infections, small size at birth, obesity, diet, air pollution, smoking (active/passive)

Spirometry is recommended for diagnosis.  FVC, FEV1, before and after bronchodilator

PEF (peak expiratory flow) changes from morning to night are an objective indicator.

Dx: episodic symptoms of airflow obstruction must be present, must be at least partially reversible, and other diag. ruled out.

persistent cough, especially at night

increased residual volume, peak expiratory flow decreases. Leads to respiratory alkalosis & hypocapnea.

Peak Expiratory Flow (PEF)

Spirometry including post-bronchodilator response to prove > or = 15% reversibility

PEFR or FEV1 > 80%

PFT variability > 20%

PEFR or FEV1 > 80%

PFT variability 20-30%

PEFR or FEV1 60-80%

PFT variability > 30%

PEFR or FEV1 < or = 60%

PFT variability > 30%

SABA PRN up to 4xdaily

(no long-term med needed)

ICS (low-dose) for maintenance

SABA PRN

ICS + LABA combo

            or

Medium dose ICS

(may add leukotriene modifier, theophylline)

SABA PRN

Medium/high dose ICS + LABA

leukotriene modifier or theophylline

low dose oral corticosteroid

XOLAIR (anti-IgE)