Asthma Review | Mnemonics And Other Proven Ways To Memorize for the PANCE, PANRE

Summary

This video covers asthma treatment guidelines, focusing on the GINA and NAEPP 2020 guidelines. It provides a step-by-step explanation of treatment based on the severity of asthma, ranging from intermittent symptoms to severe persistent cases. Key treatments include SABAs, inhaled corticosteroids (ICS), and LABAs like formoterol, with dosage adjustments based on symptoms and lung function. A mnemonic '2 4 8 and then an 8 on its side' is introduced to help remember the steps, especially the frequency of nighttime awakenings for each stage. The video also briefly reviews common asthma questions and concepts for exam preparation.

Takeaways

• 😀 Intermittent asthma (Step 1) is treated with SABA as needed, with symptoms occurring ≤2 days/week and ≤2 nocturnal awakenings/month.
• 😀 Mild persistent asthma (Step 2) is treated with low-dose ICS plus SABA as needed, with symptoms >2 but <7 days/week and 3-4 nocturnal awakenings/month.
• 😀 Moderate persistent asthma (Step 3) requires LABA (e.g., formoterol) plus low-dose ICS, with symptoms occurring every day and ≥8 nocturnal awakenings/month.
• 😀 Severe persistent asthma (Step 4) is treated with LABA (e.g., formoterol) plus medium-dose ICS, with symptoms present all day and every night.
• 😀 For refractory asthma (Steps 5-6), treatments may include increased doses of ICS, LAMA (e.g., tiotropium), and biologics.
• 😀 The NAEPP 2020 guidelines are more complex but important for PA school exams, and the focus is on asthma severity and frequency of symptoms.
• 😀 A helpful mnemonic for the guidelines is '2-4-8 and infinity,' which refers to nocturnal awakenings and corresponding treatments.
• 😀 '2' stands for ≤2 nocturnal awakenings/month (Step 1), '4' for 3-4 awakenings/month (Step 2), and '8' for ≥8 awakenings/month (Step 3).
• 😀 The 'infinity' symbol represents Step 4, where nocturnal awakenings occur every night, indicating severe persistent asthma.
• 😀 Remember the classic triad of asthma symptoms: wheezing, cough, and dyspnea, which are key indicators of the disease.

Q & A

What is the primary treatment focus in the GINA guidelines for asthma management?

The primary focus in the GINA guidelines is on low-dose inhaled corticosteroids (ICS), with step-ups to higher doses and the addition of long-acting beta-agonists (LABA) as needed.

How are asthma patients classified in the NAEPP 2020 guidelines?

In the NAEPP 2020 guidelines, asthma patients are classified into four stages based on the frequency and severity of their symptoms: Step 1 (intermittent), Step 2 (mild persistent), Step 3 (moderate persistent), and Step 4 (severe persistent). Steps 5-6 are for refractory cases requiring intensive treatment.

What treatment is recommended for patients with Step 2 (mild persistent) asthma in the NAEPP guidelines?

For Step 2 asthma (mild persistent), the treatment involves the use of inhaled corticosteroids (ICS) plus a short-acting beta-agonist (SABA) as needed (PRN).

What distinguishes Step 3 (moderate persistent) asthma from Step 2 in the NAEPP guidelines?

In Step 3 (moderate persistent) asthma, patients experience daily symptoms and nocturnal awakenings more than once a week (8+ nights/month), with a decrease in FEV1 (60-80% predicted). Treatment involves the addition of a long-acting beta-agonist (LABA) along with low-dose ICS.

Why is the mnemonic '2-4-8 and Infinity' helpful for remembering asthma treatment steps?

The mnemonic '2-4-8 and Infinity' helps remember the frequency of nocturnal awakenings in each asthma step (2, 4, 8, and infinite for severe cases). It also helps to recall the corresponding treatments: SABA for Step 1, ICS + SABA for Step 2, LABA + ICS for Step 3, and a medium-dose ICS for Step 4.

What is the key difference between the NAEPP Step 3 and Step 4 treatments?

The key difference between Step 3 and Step 4 treatment is that in Step 4, the ICS dose is increased to a medium dose, while in Step 3, a low-dose ICS is combined with a LABA. Step 4 also involves more severe symptoms and significantly lower FEV1.

What does the mnemonic 'Infinity' (8 on its side) represent in asthma treatment?

'Infinity' represents the continuous nature of symptoms in Step 4 (severe persistent asthma), where patients experience symptoms every day and night without relief, and the treatment includes an increased dose of inhaled corticosteroid (ICS).

What test is considered the gold standard for diagnosing asthma?

The gold standard for diagnosing asthma is the pulmonary function test, specifically spirometry, which measures lung function and helps assess airflow obstruction.

Which asthma medication should never be used as monotherapy, according to the guidelines?

Long-acting beta-agonists (LABAs), such as formoterol, should never be used as monotherapy for asthma. They must always be combined with an inhaled corticosteroid (ICS) to avoid potential risks.

What is the minimum increase in FEV1 required in a bronchodilator challenge to diagnose asthma?

In a bronchodilator challenge, a 12% or greater increase in FEV1 (forced expiratory volume in one second) is considered a positive result, indicating that the patient likely has asthma.