Asthma reloaded!

OUTPATIENT MANAGEMENT

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 

PEARLS!


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?