NR565 WK 6 Asthma 1 Asthma Treatment Algorithm: To successfully treat asthma, you must first classify it and then be familiar with step therapy. For this assignment and in this course, we will focus on patients 12 years and older. Complete the blanks in the following table to create an algorithm for asthma care using your textbook as well as GINA guidelines . Step Asthma Classificatio n Asthma symptoms and frequency as noted in textbook Controller and Preferred Reliever: (Drug Class and frequency if provided from GINA guidelines) Controller and Alternative Reliever: (Drug Class and frequency if provided from GINA guidelines) Step 1 Intermittent Daytime symptoms 2 Days/Week or less Drug class: Low dose ICSformoterol Frequency: As needed Drug class: SABA Nighttime Frequency: When ICS is taken awakenings 2 times/month of less Step 2 Mild Persistent Daytime symptoms More than 2 days/week but less than daily Drug class: Low dose maintenance ICS and As needed SABA Nighttime awakenings 3-4 times/month Step 3 Moderate Persistent Daytime symptoms Daily Drug class: Low dose maintenance ICSformoterol and As-needed low dose ICS-formoterol Drug class: Low dose maintenance ICS-LABA and As needed SABA Nighttime awakenings More than once/week but less than nightly Step 4-5 Severe Persistent Daytime symptoms Several times daily Step 4: Drug class: Medium dose maintenance ICS-formoterol and As-needed low dose ICSformoterol Drug class: Medium/high dose maintenance ICS-LABA and As needed SABA Nighttime awakenings Often nightly Step 5: Drug class: Add on LAMA and use No change. This study source was downloaded by 100000863292528 from CourseHero.com on 10-15-2023 14:13:54 GMT -05:00 https://www.coursehero.com/file/158967929/Week-6-Case-Studydotx/ NR565 WK 6 Asthma 2 as-needed low dose ICS-formoterol Refer for: Phenotypic assessment anti-igE, anti IL5/5R, anti IL4R Starting treatment: Complete this section using the GINA guidelines provided. First Assess: 1. Confirm diagnosis 2. Symptom control and modifiable risk factors including lung function 3. Comorbidities 4. Inhaler technique and adherance 5. Patient preferences and goals 6. Click or tap here to enter text. Fill in the blank: 1. Using ICS-formoterol as reliever reduces the risk of exacerbations compared with using a SABA reliever. 2. Before considering a regimen with a SABA reliever, check if the patient is likely to be adherent with daily controller therapy. This study source was downloaded by 100000863292528 from CourseHero.com on 10-15-2023 14:13:54 GMT -05:00 https://www.coursehero.com/file/158967929/Week-6-Case-Studydotx/ NR565 WK 6 Asthma 3 Dosing: Low, Medium, High Low dose ICS provides most of the clinical benefit for most patients. However, ICS responsiveness varies between patients, so some patients may need medium dose ICS if asthma is uncontrolled despite good adherence and correct inhaler technique with low dose ICS. High dose ICS is needed by very few patients, and its long-term use is associated with an increased risk of local and systemic side-effects. Adults and adolescents Inhaled corticosteroid Total daily (24 hour) ICS dose (mcg) Low Medium High BDP (pMDI, HFA) 200-500 >500-1000 >1000 BDP (DPI or pMDI, extrafine particle, HFA) 100-200 >200-400 >400 Budesonide (DPI or PMDI, HFA) 200-400 >400-800 >800 Ciclesonide (pMDI, extrafine particle, HFA) 80-160 >160-320 >320 Fluticasone furoate 100 200 Fluticasone propionate (DPI) 100-250 >250-500 >500 Fluticasone propionate (pMDI, HFA) 100-250 >250-500 >500 Mometasone furoate (pMDI, HFA) 200-400 400 Treating Modifiable Risk Factors Exacerbation risk can be minimized by optimizing asthma medications and by identifying and treating modifiable risk factors. List the six modifiable risk factors identified in the GINA guidelines that show consistent high-quality evidence. 1. Guided self-management: self monitoring of symptoms and/or PEF, a written asthma action plan and regular medical review 2. Use of a regimen that minimizes exacerbations: prescribe an ICS-containing controller, either faily, or, for mild asthma, asneeded ICS formoterol. Maintenance and reliever therapy (MART) with ICS-formoterol reduces the risk of severe exacerbations in comparison with using SABA as a reliever 3. Avoidance of exposure to tobacco smoke 4. Confirmed food allergy: appropriate food avoidance; ensure that injectable epinephrine for anaphylaxis is available 5. School-based programs that include asthma self-management skills 6. Referral to a specialist center if there is one available for patients with severe asthma.