2020 GINA guidelines vs 2007 NAEPP guidelines
- GINA recommends that EVERY adolescent and adult with asthma use an ICS-containing inhaler, and that no adolescent or adult receive SABA-only treatment. But why?
- ICS markedly reduce the frequency of asthma exacerbations, hospitalizations, and death. Plus ICS are effective in reducing asthma symptoms, improving lung function, and preventing exercise-induced bronchoconstriction
- Compared with ICS, patients treated with SABA alone are at higher risk of asthma-related death and urgent asthma-related healthcare
- Want more info but don’t want to read GINA’s 200-page guideline? Here’s a GREAT summary of the evidence
- It’s difficult to diagnose asthma in kids <5yo, but the modified Asthma Predictive Index and Pediatric Asthma Risk Score (both for kids ≤3yo) can help us predict its likelihood
- Allergic sensitization (by skin test) may be the strongest predictor of asthma
- We don’t do a great job of checking PFTs in patients with a diagnosis of asthma
- We also don’t do a great job of recognizing if adult patients still have asthma
- The SMART thing to do is to never use a LABA alone in managing asthma
- TALC: Adding tiotropium may be just as effective as adding salmeterol in patients with poorly-controlled asthma already on an ICS
FUN FACTS ABOUT INHALERS!
- Many studies show that most patients (maybe 80%!) don’t use their inhalers correctly, but maybe half of clinicians don’t know how to use them either
- But help is on the way! Our amazing clinic pharmacist (Kat!) is putting together a box of sample inhalers that we can use to learn and teach patients in clinic!
- Many inhalers have dose-counters, but not all! Without a dose-counter, it may be difficult for patients to know how much medication is left in their inhaler
- Inhalers are expensive!
QUESTIONS TO PONDER!
- Are there respiratory symptoms that make a diagnosis of asthma less likely?
- Can you have asthma without wheezing?
- Apart from chest auscultation, what physical exam findings should we look for when evaluating patients for asthma?
- Should we always check PFTs in evaluating asthma? Is it better to check PFTs when asthma symptoms are well-controlled or uncontrolled? Should we ever recheck PFTs?
- What comorbidities affect asthma control? How does pregnancy affect asthma?
- What risk factors predict future asthma exacerbations?
- What is the difference between metered-dose inhalers and dry powder inhalers? Does every inhaler need a spacer? And is it ever better to prescribe a nebulizer?
- Which patients should we refer for allergy testing? And which to refer to pulmonology?