Pulmonology Book

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Severe Persistent Asthma

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  1. See Also
    1. Asthma Education
    2. Asthma Management
    3. Mild Intermittent Asthma
    4. Mild Persistent Asthma
    5. Moderate Persistent Asthma
  2. Criteria
    1. Continuous Symptoms
      1. Interferes with sleep and activity
    2. Frequent exacerbations and nocturnal symptoms
    3. Pulmonary Function Tests
      1. FEV1 or PEF <60% of predicted
      2. PEF variability > 30%
  3. Management
    1. Rule out Other Etiologies
      1. Non-compliance
      2. Cystic Fibrosis
    2. Long-term daily control medication
      1. Inhaled Corticosteroid (High dose) and
      2. Long acting beta agonist Bronchodilator and
      3. Leukotriene Receptor Antagonist (Montelukast)
      4. Systemic Corticosteroids (2 mg/kg/day to 60 mg/day)
      5. Consider Anti-IgE Therapy (Omalizumab)
        1. Indicated in severe refractory (Step 5-6) Asthma with IgE levels >75
        2. Subcutaneous injection every 2-4 weeks
    3. Other measures
      1. Short term rescue with beta agonist
      2. Asthma Education
  4. References
    1. (1997) Management of Asthma, NIH 97-4053
    2. (1995) Global Strategy for Asthma, NIH 95-3659
    3. Kalister (2001) West J Med 174:415
    4. Kemp (2001) Am Fam Physician 63(7):1341

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