Pulmonary Function Tests

FEV1/FVC: 0.857

Postbronchodilator FEV1: 1.70 L (13.3% increase) FEV1 after exercise: 1.23 L (23.1% decrease)

Given this additional information, what is your assessment of the patient's asthma severity?

Identify your treatment goals for this patient.

What nonpharmacologic and pharmacologic alternatives are feasible for this patient?

Outline a treatment plan for this patient that includes nonpharmacologic therapy, pharmacologic therapy, and a monitoring plan. Justify your therapeutic selections.

Children Up to 4 Years of Age (Fig. 14-2)

Long-term control medications should be initiated in patients who have had: (a) four or more episodes within the last year that have lasted for a day or longer and affected sleep and (b) have one major or two minor risk factors for developing persistent asthma. Major risk factors include a parental history of asthma, diagnosis of atopic dermatitis, and evidence of sensitization to aeroallergens. Minor risk factors include sensitization to food, 4% or more eosinophils in peripheral blood, and wheezing apart from colds. In addition, controller therapy should be considered if the patient requires symptomatic treatment for more than 2 days a week for more than 4 weeks or has two

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asthma exacerbations requiring systemic corticosteroids within 6 months. '

Daily ICS are the preferred long-term control therapy in all steps, and nonpreferred alternatives are cromolyn or a leukotriene receptor antagonist. Patients not controlled on low doses of ICS should be increased to medium doses before adding other therapies. Because high-dose ICS may be associated with significant adverse effects, addition of a leukotriene receptor antagonist or LABA to medium-dose therapy is preferred before increasing the ICS dose further. Theophylline is not recommended as an alternative at any step in this age group.1

Children 5 to 11 Years of Age (Fig. 14-2)

Daily ICS are the preferred long-term control therapy in all steps. Nonpreferred alternatives are cromolyn, a leukotriene receptor antagonist, nedocromil, or theophylline. For patients not controlled on low-dose ICS, the addition of an LABA, leukotriene receptor antagonist, or theophylline to current therapy or increasing to medium-dose ICS are equivalent options. In patients not controlled on medium-dose ICS or low-dose ICS plus adjunctive therapy, the addition of an LABA to medium-dose ICS is preferred over other adjunctive therapies.1

Individuals 12 Years of Age and Older (Fig. 14-2)

Daily ICS are the preferred long-term control therapy in all steps. Nonpreferred alternatives include cromolyn, a leukotriene receptor antagonist, nedocromil or sustained-release theophylline. For patients not controlled on low doses of ICS, the addition of a LABA, or increasing to medium-dose ICS are equivalent options.1 The addition of other add-on therapies (leukotriene rece1ptor antagonist, sustained-release theophyl-line, or zileuton) are nonpreferred options. Omalizumab maybe considered in patients not controlled on high-dose ICS and an LABA.

Coping with Asthma

Coping with Asthma

If you suffer with asthma, you will no doubt be familiar with the uncomfortable sensations as your bronchial tubes begin to narrow and your muscles around them start to tighten. A sticky mucus known as phlegm begins to produce and increase within your bronchial tubes and you begin to wheeze, cough and struggle to breathe.

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