CAE C-Management

to achieve and maintain control

• 1. Improve quality of life by maintaining the pt's lung function and activity level as normal as possible
• 2. Reduce the risk of exacerbations, hospitializations, loss of lung function, or impared development

Professional and patient

The intrinsic intensity of the disease

The degree to which manifistations are minimized and goals of therapy are met

The ease by which control is achieved

The frequency and intensity of symptoms and funcitonal limitations the patient is experiencing or recently experienced (present)

The likelihood of exacerbations, decline in lung function, imparement of development or adverse effects of medication (future)

• Early: within 1 hour of exposure to allergen, use SABA and antihistamines
• Late: 3 to eight hours after exposure, often more severe, use corticosteroids

• Phase I: Initial Control
• (Classification and Initial Therapy)

• Phase II: Maintaining Control
• (Patient Monitoring and Therapy Adjustment)

Age and SALSA

To quickly achieve control

• SALSA
• Peak Flow
• Follow-up visits
• Questionaires

• Primary assessment tool
• Early detection of deteriorating airflow
• Most helpful for moderate to severe asthma

• Record PF every morning and afternoon for 2-3 weeks
• Record PF after SABA and DO
• Highest is Personal Best
• Repeat occasionally to note changes in Personal Best

• 10 L/sec
• 600 L/min

• 80-100% of Personal Best
• Good control
• Children <6: No cough, wheeze, chest tightness, SOB day or night, normal activities

• 50-79% Personal Best
• Worsening Asthma
• Children <6: has cough, wheeze, chest tightness, SOB, waking at night with symptoms, most activities

• <50% of Personal Best
• Medical attention is needed
• Children <6: very SOB, SABA has no effect, cannot do usual activities, symptoms same / worse after time in yellow zone

• 1. Every morning before meds
• 2. During symptoms
• 3. After meds during attack
• 4. During clinical visit

• Dust and dirt, germs and mucuous affect readings
• Wash once a week normally
• Wash after every use if a virus
• Remove mouthpiece
• Wash both in warm soapy water
• Rinse and air dry

every 6 months

• ATAQ: <1 is good
• ACQ: <1 is good
• ACT: >20 is good

• 1. Maintain at current step
• 2. FU every 1 to 6 months
• 3. Consider step down if well controlled 3 months

• 1. Step up one step
• 2. Re-eval 2 to 6 weeks
• 3. If side effects, consider alt treatment options
• 4. FU every 1 to 6 months
• 5. Consider step down if well controlled 3 months

• 1. Step up 1 to 2 steps
• 2. Re-eval in 2 weeks
• 3. Consider short course oral systemic steroids
• 4. If side effects, consider alt treatment options
• 5. FU every 1 to 6 months
• 6. Consider step down if well controlled 3 months

Consider alternative diagnosis

• MDI/DPI technique
• Adherence to medication regime
• Environmental control
• Co-morbities

25% every 2 to 3 months until lowest dose to maintain control is reached.

• > 1 SABA canister per month
• Awakened at night with symptoms
• Have urgent care visit

• Chemicals, pollens, mold spores
• Animal dander
• Mold in vents, odors from printers, fumes from AC/heat

• Do other children have same symptoms?
• Improve away from bldg?
• Appear after pesticides, painting or construction?

• Number one source of indoor pollution
• Not permitted in house

• Use HEPA filters (3 microns)
• Use ULPA (0.12 microns)
• Vacuums and air purifiers should use these

Bedroom

• No pets best, keep outside 2nd best
• If must have indoors, not in bedroom
• Bathe once per week
• After playing, wash hands before touching pt/bedroom
• Have someone else clean hamster/mice cage
• Exterminate cockroaches
• Control mice with block access or low-toxic pesticide

• Plastic zippered covers for matress and pillows
• Wash linen in water >130 or detergent and bleach
• Use synthetic materials for bedding
• Remove carpet
• Keep humidity between 30 to 50%
• Avoid upholstered furniture
• Vacuum one per week
• Use mask when dusting
• Use AC instead of windows
• Avoid stuffed animals (freeze once per wk for 6 hrs)

• Use no windows, but AC
• Clean / replace AC filters regularly
• Know triggers and avoid outdoor activities then
• Bathe before bedtime
• Don't dry clothes outdoors

• Keep humidity <50%
• Clean mold from refrigerator and inside house
• Don't dry clothes outside
• Avoid live or dried plants inside house
• Have someone else mow and garden

• Avoid food completely
• Carry EpiPen

• Epinephrine
• Antihistamines
• Hydrocortisone
• O2
• Orpharyngeal Airway
• IV fluids
• Ambulance called, keep at leat 12 hours
• (attacks happen up to 8 hours later)

• Avoid
• Use Acetaminophen instead

• Common causes are:
• Lates
• Gases, chemicals, fumes
• Tobacco smoke, perfume
• Temp and humidity
• Formaldehyde and volitile organic compounds
• Platinum, chromium and nickel sulfate

• Use SABA 15 to 30 minutes before
• Use midway if needed
• Use LABA 30 minutes before
• Use Cromolyn Sodium or Nedocromil 15 to 30 min
• Use inhaled corticosteroids to control
• Use leukotriene modifiers regularly
• Wear mask or scarf in cold weather