Source: http://allergycases.blogspot.com/2007/01/mnemonics-asthma.html
Mnemonics: Asthma
Author: V. Dimov, M.D., Allergist/Immunologist and Assistant Professor at University of Chicago
Reviewer: S. Randhawa, M.D., Allergist/Immunologist and Assistant Professor at LSU (Shreveport) Department of Allergy and Immunology
Asthma is the most common chronic respiratory disease, affecting up to 10% of adults and 30% of children (JACI, 2011). Prevalence of asthma is 8%, prevalence of AR is 3 times higher (24%). 40% of patients with AR have asthma, 80% of patients with asthma have AR.
Allergic Rhinitis and its Impact on Asthma (ARIA): Achievements in 10 years and future needs. ARIA has reclassified AR as mild/moderate-severe and intermittent/persistent. This classification closely reflects patients' needs and underlines the close relationship between rhinitis and asthma. http://buff.ly/QL1eYI
Pathogenesis of Asthma
Lymphocytes
CD4, Th2
Central effector cells
Cytokine release
Overview of adhesion molecules, 3 groups remembered by the mnemonic SIS:Selectins
Integrins
Superfamily Ig
Mast cells are subdivided into 2 types based on proteinase content:
TC mast cells -- Tryptase and Chymase in granules
T mast cells -- Tryptase only granules
Mast cells
Mediator release
Mucosal inflammation
Mediators from eosinophils are remembered by the mnemonic CML EEE:
Cytokines
MBP
Lipid Mediators
EDN
ECP
EPO
Eosinophils
Emit
Eight mediators (at least 8, the first C in the mnemonic covers cytokines, chemokines and growth factors)
Overview of adhesion molecules, 3 groups remembered by the mnemonic SIS:Selectins
Integrins
Superfamily Ig
There are 4 families of eicosanoids (PP-LT): prostaglandins (PG), prostacyclins (PGI), leukotrienes (LT) and thromboxanes (TX).
Diagnosis of Asthma
A mnemonic to remember the different PFTs is SPIROMEtry:
Spirometry
PEFR
Inhalation tests:
Reversibilty of
Obstruction with beta-agonist
Metacholine challenge
Exhaled NO
The phases of spirometry can be remembered by the mnemonic BEIF:
Breath normally x 6 times
Exhale fully
Inhalation (deep)
Forceful exhalation for 6 seconds
FEV1/FVC
FEF 25-75
R
Regular (normal) or
Raised in
Restriction
FEV1
1ow in both obstructive and restrictive disease
Bronchodilation test: BB RRBaseline spirometry
Beta-agonist
Repeat spirometry
Reversibilty of obstruction
Methacholine challenge test, remember the numbers: 5-25-20-5:
5 breaths
25 mg/mL metacholine
20% FEV1 reduction
5% of patients with asthma have a negative test, 95% react to the challenge
Test for Respiratory and Asthma Control in Kids (TRACK)
5
5 questions
5 year-old or younger (2-5 years)
Test for respiratory and asthma control in kids (TRACK) - mnemonic: 3S
Symptoms (3 questions)
SABA use
Steroid use
Test for respiratory and asthma control in kids (TRACK) - complete mnemonic: 3S
Symptoms - SPA: Symptoms - how often, Play, At night, past 4 weeks
SABA use, past 12 weeks (3 months)
Steroid use, past 12 months (1 year)
Time frame of TRACK:
Symptoms - 4 weeks (1 month)
SABA use - 12 weeks (3 months), quarter
Steroid use - 12 months (1 year)
References:
Test for Respiratory and Asthma Control in Kids (TRACK): A caregiver-completed questionnaire for preschool-aged children. Kevin R. Murphy et al. JACI. Volume 123, Issue 4, Pages 833-839.e9 (April 2009).
Differential Diagnosis of Asthma
C
Children
Congenital conditions
CF
A
Adults
Acquired conditions
Asthma Classification: M MMS
Mild intermittent
Mild persistent
Moderate persistent
Severe persistent
Treatment
One can remember the stages by the number of controller medications a patient would need at each stage:
I'M MS
0 1 2 3
"Rule of 2s” is used to determine level of control. If any of these are positive, consider a daily controller medication:
- daytime symptoms more than 2 days/wk
- rescue β2 -agonist use more than 2 times per week
- nighttime symptoms more than 2 nights/mo
- more than 2 asthma exacerbations per year
- more than 2 rescue β2-agonist canisters/yr
Reference for rule of 2's: Audio: Asthma, noon conference. Muthiah Pugazhenthi. Podcasting Project for the UT Internal Medicine Residency Program, 12/2006.
3 C's of care - communication, continuity, concordance (finding common ground) are critical for asthma management (http://goo.gl/8gJM6).
Medications
S
Singulair
Single daily dose
Suicude risk (potential)
LABA
M
Monotherapy
Masks inflammation
Mortality increase
Corticosteroids
C category during pregnancy
Budesonide
B category during pregnancy
Exercise-induced asthma treatment: CLIMB
Cromolyn
Leukotriene receptor antagonist
Inhaled steroids
Mast cell stabilizers other than cromolyn
Beta agonists
Leukotriene receptors
Leukotriene
B4
BLT 1, 2 receptors
Leukotriene
C4, D4, E4
CysLT 1, 2 receptors
Published: 01/24/2008
Updated: 11/27/2012
Reviewer: S. Randhawa, M.D., Allergist/Immunologist and Assistant Professor at LSU (Shreveport) Department of Allergy and Immunology
Asthma is the most common chronic respiratory disease, affecting up to 10% of adults and 30% of children (JACI, 2011). Prevalence of asthma is 8%, prevalence of AR is 3 times higher (24%). 40% of patients with AR have asthma, 80% of patients with asthma have AR.
Classification of asthma - mnemonic
I'M MS ("I'm a Master of Science")
Intermittent
Mild persistent
Moderate persistent
Severe persistent
Number of controllers used in each stage of the classification of asthma - mnemonic:
I'M MS
0 1 2 3
0 - SABA PRN (albuterol) only
1 - ICS or LTRA
2 - ICS/LABA or ICS plus LTRA
3 - ICS/LABA and LTRA, consider omalizumab (anti-IgE mAb)
Allergic Rhinitis and its Impact on Asthma (ARIA): Achievements in 10 years and future needs. ARIA has reclassified AR as mild/moderate-severe and intermittent/persistent. This classification closely reflects patients' needs and underlines the close relationship between rhinitis and asthma. http://buff.ly/QL1eYI
Pathogenesis of Asthma
Lymphocytes
CD4, Th2
Central effector cells
Cytokine release
Overview of adhesion molecules, 3 groups remembered by the mnemonic SIS:Selectins
Integrins
Superfamily Ig
Mast cells are subdivided into 2 types based on proteinase content:
TC mast cells -- Tryptase and Chymase in granules
T mast cells -- Tryptase only granules
Mast cells
Mediator release
Mucosal inflammation
Mediators from eosinophils are remembered by the mnemonic CML EEE:
Cytokines
MBP
Lipid Mediators
EDN
ECP
EPO
Eosinophils
Emit
Eight mediators (at least 8, the first C in the mnemonic covers cytokines, chemokines and growth factors)
Overview of adhesion molecules, 3 groups remembered by the mnemonic SIS:Selectins
Integrins
Superfamily Ig
There are 4 families of eicosanoids (PP-LT): prostaglandins (PG), prostacyclins (PGI), leukotrienes (LT) and thromboxanes (TX).
Diagnosis of Asthma
A mnemonic to remember the different PFTs is SPIROMEtry:
Spirometry
PEFR
Inhalation tests:
Reversibilty of
Obstruction with beta-agonist
Metacholine challenge
Exhaled NO
The phases of spirometry can be remembered by the mnemonic BEIF:
Breath normally x 6 times
Exhale fully
Inhalation (deep)
Forceful exhalation for 6 seconds
FEV1/FVC
FEF 25-75
R
Regular (normal) or
Raised in
Restriction
FEV1
1ow in both obstructive and restrictive disease
Bronchodilation test: BB RRBaseline spirometry
Beta-agonist
Repeat spirometry
Reversibilty of obstruction
Methacholine challenge test, remember the numbers: 5-25-20-5:
5 breaths
25 mg/mL metacholine
20% FEV1 reduction
5% of patients with asthma have a negative test, 95% react to the challenge
Test for Respiratory and Asthma Control in Kids (TRACK)
5
5 questions
5 year-old or younger (2-5 years)
Test for respiratory and asthma control in kids (TRACK) - mnemonic: 3S
Symptoms (3 questions)
SABA use
Steroid use
Test for respiratory and asthma control in kids (TRACK) - complete mnemonic: 3S
Symptoms - SPA: Symptoms - how often, Play, At night, past 4 weeks
SABA use, past 12 weeks (3 months)
Steroid use, past 12 months (1 year)
Time frame of TRACK:
Symptoms - 4 weeks (1 month)
SABA use - 12 weeks (3 months), quarter
Steroid use - 12 months (1 year)
References:
Test for Respiratory and Asthma Control in Kids (TRACK): A caregiver-completed questionnaire for preschool-aged children. Kevin R. Murphy et al. JACI. Volume 123, Issue 4, Pages 833-839.e9 (April 2009).
Differential Diagnosis of Asthma
C
Children
Congenital conditions
CF
A
Adults
Acquired conditions
Asthma Classification: M MMS
Mild intermittent
Mild persistent
Moderate persistent
Severe persistent
Treatment
One can remember the stages by the number of controller medications a patient would need at each stage:
I'M MS
0 1 2 3
"Rule of 2s” is used to determine level of control. If any of these are positive, consider a daily controller medication:
- daytime symptoms more than 2 days/wk
- rescue β2 -agonist use more than 2 times per week
- nighttime symptoms more than 2 nights/mo
- more than 2 asthma exacerbations per year
- more than 2 rescue β2-agonist canisters/yr
Reference for rule of 2's: Audio: Asthma, noon conference. Muthiah Pugazhenthi. Podcasting Project for the UT Internal Medicine Residency Program, 12/2006.
If asthma treatment is not working, check DAT:
Diagnosis - not asthma at all (VCD, CF, FBA), asthma plus AR, GERD
Adherence - compliance with medication
Technique - NEB, HFA with spacer, DPI, etc.
3 C's of care - communication, continuity, concordance (finding common ground) are critical for asthma management (http://goo.gl/8gJM6).
Medications
S
Singulair
Single daily dose
Suicude risk (potential)
LABA
M
Monotherapy
Masks inflammation
Mortality increase
Corticosteroids
C category during pregnancy
Budesonide
B category during pregnancy
Exercise-induced asthma treatment: CLIMB
Cromolyn
Leukotriene receptor antagonist
Inhaled steroids
Mast cell stabilizers other than cromolyn
Beta agonists
Leukotriene receptors
Leukotriene
B4
BLT 1, 2 receptors
Leukotriene
C4, D4, E4
CysLT 1, 2 receptors
Ciclesonide mnemonic
C
Ciclesonide
Converted to active form (des-CIC)
Carboxyl-esterases in bronchial epithelial cells
Clearance by liver
Published: 01/24/2008
Updated: 11/27/2012
Post a Comment